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.
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 (≥10%) comprised the independent variables. Logistic regression analyses, incorporating the sampling weights, were employed.
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.
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.
This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders.
This study used data from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 non-Hispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM as well as the use of CAM only compared to CAM use with services in another treatment sector.
Thirty-five percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM although there was no racial or ethnic difference in CAM use only vs. CAM use with traditional services. A higher proportion of blacks used prayer and other spiritual practices compared to whites. Among those with a mood disorder, black Caribbeans were less likely to use any CAM than African Americans.
Patterns of CAM use for treatment of mental disorders are similar to those found in relation to physical illness. The use of prayer is a major factor in racial differences in CAM use, however there are differences among black Americans that warrant further research.
There are widespread assumptions that a large proportion of American adults use a variety of complementary and alternative medicine (CAM) therapies. The goal of this study is to explore the clustering or linkages among CAM categories in the general population. Linkset analysis and data from the 2002 National Health Interview Survey (NHIS) were used to address two specific aims. First, the dominant linkages of CAM categories used by the same individual were delineated, and population estimates were generated of the percentage of American adults using different linksets of CAM categories. Second, it was determined whether dominant linkages of CAM modalities differ by age, gender, ethnicity, and education.
Linkset analysis, a method of estimating co-occurrence beyond chance, was used on data from the 2002 NHIS (N = 29,862) to identify possible sets of CAM use.
Most adults use CAM therapies from a single category. Approximately 20% of adults combined two CAM categories, with the combination of mind–body therapies and biologically based therapies estimated to be most common. Only 5% of adults use therapies representing three or more CAM categories. Combining therapies across multiple CAM categories was more common among those 46–64, women, whites, and those with a college education.
The results of this study allow researchers to refine descriptions of CAM use in the adult population. Most adults do not use a wide assortment of CAM; most use therapies within a single CAM category. Sets of CAM use were found to differ by age, gender, ethnicity, and education in ways consistent with previous research.
This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework.
Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies.
The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status).
CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.
Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
Analysis of the 2002–2008 Medical Expenditure Panel Survey.
Adults (> 17 years) with self-reported neck and back problems who did or did not use CAM services.
Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic and health characteristics.
A total of 12,036 respondents with spine problems were included, including 4,306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared to non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95%CI $240, $609; p <0.001) for spine-related costs, and $796 lower (95%CI $121, $1470; p = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (p<0.001) and $298 lower for total health costs (p=0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. Since the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
Back and neck pain; complementary and alternative medicine; expenditures
This study investigated the demographic, behavioral, and health correlates of the most frequently used types of complementary and alternative medicine (CAM) therapy and the use of prayer for health among midlife women. We also examined the extent to which women used CAM for treatment of health conditions, including menopausal symptoms, and for general health and well-being.
Data from the 2002 National Health Interview Survey (NHIS), a cross-sectional, household survey representative of the U.S. civilian adult population, were used. Midlife women aged 40–59 years (n = 5849) were analyzed. Bivariate prevalence estimates were obtained, and binomial logistic regression models were estimated; all analyses were weighted.
Overall, 46% of midlife women used any type of CAM in the past 12 months, and 54% reported using prayer for health reasons. The top five specific CAM therapies used were herbs and natural products; relaxation techniques; chiropractic care; yoga, tai chi, or qi gong; and massage. Multivariate results demonstrated different patterns of association between demographic, health, and behavioral characteristics and specific CAM therapies. A higher percentage of women used chiropractic care for an existing health condition than those using relaxation techniques, and few women used CAM specifically for menopausal symptoms.
CAM and prayer are frequently used by midlife women, and herbs and natural supplements are the mostly frequently used. The findings underscore the importance, particularly in the clinical setting, of asking women about their use of individual CAM therapies. Such clinical assessment is also important because of the potential for interactions of CAM therapies with prescribed therapies.
The current study investigated the relationship of pain to use of complementary and alternative medicine (CAM) in a U.S. nationally representative sample of 2466 persons with HIV using data from the HIV Cost and Services Utilization Study (HCSUS). Pain was conceptualized as a need characteristic within the context of predisposing, enabling, and need (PEN) characteristics following Andersen's Behavioral Model of Health Services Use. Multivariate analyses were used to examine the association of baseline PEN characteristics with CAM use by follow-up (approximately 6 months later), including use of five specific CAM domains. Change in pain from baseline to follow-up was also examined in relation to CAM use. Baseline pain was a strong predictor of CAM use, and increased pain over time was associated with use of unlicensed or underground drugs with potential for harm. These results highlight the importance of medical efforts to control pain in persons living with HIV.
Complementary medicine; alternative medicine; human immunodeficiency virus; pain
To evaluate the effect of ethnicity as a predictor of the use of complementary and alternative medicine (CAM) among patients with diabetes.
Design and Settings
A 16-item questionnaire investigating CAM use was distributed among patients attending the Taking Control of Your Diabetes (TCOYD) educational conferences during 2004-2006. Six TCOYD were held across the United States. Information of diabetes status and sociodemographic data was collected. CAM use was identified as pharmacological (herbs and vitamins) and nonpharmacological CAM. (e.g., prayer, yoga, and acupuncture).
The prevalence of pharmacological and non-pharmacological CAM among 806 participants with diabetes patients was 81.9% and 80.3%, respectively. Overall, CAM prevalence was similar for Caucasians (94.2%), African Americans (95.5%), Hispanics (95.6%) and Native Americans (95.2%) and lower in Pacific Islanders/Other (83.9%) and Asians (87.8%). Pharmacologic CAM prevalence was positively associated with education (p = 0.001). The presence of diabetes was a powerful predictor of CAM use. Several significant ethnic differences were observed in specific forms of CAM use. Hispanics reported using frequently prickly pear (nopal) to complement their diabetes treatment while Caucasians more commonly used multivitamins.
Treatment with CAM widely used in persons with diabetes. Ethnic group differences determine a variety of practices, reflecting groups' cultural preferences. Future research is needed to clarify the perceived reasons for CAM use among patients with diabetes in clinical practice and the health belief system associated with diabetes by ethnic group.
complementary and alternative medicines; diabetes; ethnicity
Complementary and alternative medicine (CAM) is often used alongside conventional medical care, yet fewer than half of patients disclose CAM use to medical doctors. CAM disclosure is particularly low among racial/ethnic minorities, but reasons for differences, such as type of CAM used or quality of conventional healthcare, have not been explored.
We tested the hypotheses that disclosure of CAM use to medical doctors is higher for provider-based CAM and among non-Hispanic whites, and that access to and quality of conventional medical care account for racial/ethnic differences in CAM disclosure.
Bivariate and multiple variable analyses of the 2002 National Health Interview Survey and 2001 Health Care Quality Survey were performed.
Disclosure of CAM use to medical providers was higher for provider-based than self-care CAM. Disclosure of any CAM was associated with access to and quality of conventional care and higher among non-Latino whites relative to minorities. Having a regular doctor and quality patient–provider relationship mitigated racial/ethnic differences in CAM disclosure.
Insufficient disclosure of CAM use to conventional providers, particularly for self-care practices and among minority populations, represents a serious challenge in medical encounter communications. Efforts to improve disclosure of CAM use should be aimed at improving consistency of care and patient–physician communication across racial/ethnic groups.
complementary and alternative medicine; race/ethnicity; communication; access; quality of care
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.
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.
Outcomes include the prevalence of and trends in use of CAM services during 2002–2009 and correlates of use by race.
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).
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.
The use of complementary and alternative medicine (CAM) among Human Immunodeficiency Virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardize the efficacy of conventional HIV medication, making it critical to understand CAM use among this population.
To investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner.
African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants’ CAM use and various psychosocial and socio-demographic characteristics. Participants’ most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use.
One hundred and eighty two subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female sex, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use.
The implications of these findings are discussed and suggestions for future research are provided.
African-American; Complementary and alternative medicine; HIV/AIDS
The purpose of the current study was to develop and evaluate the psychometric properties of a culturally- and stage-of-disease-appropriate measure of complementary and alternative medicine (CAM) use among a population of African-American individuals with acquired immune deficiency syndrome (AIDS) using a mixed-method design.
Data were collected in two phases. In phase 1, qualitative data were used to refine an existing CAM measure for the specific study population in the present study. In phase 2, this refined instrument was implemented in a larger sample. The resulting numeric data were analyzed to evaluate the psychometric properties of the revised CAM instrument.
Data were collected from patients who were receiving care from the infectious disease clinic of a large, public, urban hospital in the Southeastern United States.
Patients were eligible to participate if they (1) were receiving their care from the clinic, (2) had an AIDS diagnosis, (3) were identified as African-American, (4) were ≥21 years of age, (5) spoke English, and (6) were not cognitively impaired.
Focus groups in phase 1 were conducted with a semistructured focus group guide. Participants also completed a basic sociodemographic survey. Phase 2 participants used programmed laptops to answer questions about their CAM use and several sociodemographic questions.
Information from the focus groups prompted some substantive revisions in the already-existing CAM survey. The revised instrument had satisfactory face validity and adequate test–retest reliability (r = 0.79). Furthermore, the instrument factored in a manner that was interpretable and consistent with prior findings.
In order for human immunodeficiency virus health care providers to provide the best care to their patients, they need to be informed about the types and frequency of CAM use among their patients. This can be accomplished by methodologically developing CAM instruments, rigorously implementing and assessing these instruments, and then disseminating the findings to researchers and practitioners.
The prevalence of type 2 diabetes among non-Hispanic African American adults aged 20 years and older is 11.4%, compared to 8.4% non-Hispanic whites. Given the high rate of diabetes in this population, it is important to determine whether African Americans use complementary and alternative medicine (CAM), and if so, what kind. Such information is important to healthcare professionals who prescribe therapies and make self-care recommendations to those with diabetes. The use of CAM by African Americans with diabetes has not been well studied, however, particularly among those living in rural areas. This descriptive study was conducted in 2 rural communities in Central Virginia to explore the use of CAM therapies and the role of religion and spirituality in dealing with diabetes among adult African Americans with type 2 diabetes. Sixty-eight participants attended 1 of 8 focus group sessions in various community settings and described their use of alternative therapies. According to these sessions, the most common alternative therapies used are prayer, diet-based therapies, and natural products. The participants’ descriptions enhance our understanding of CAM use among rural African Americans with diabetes.
The primary purpose of this survey was to assess the interest and concerns of a group of cancer complementary and alternative medicine (CAM) practitioners regarding CAM research issues. These issues include the CAM modalities used most often by CAM practitioners in the treatment of cancer patients, cancer CAM practitioners’ perceptions of the most promising areas of cancer CAM research, the perceived obstacles to carrying out research objectives in the emerging field of cancer CAM research, the extent of awareness of the National Cancer Institute (NCI) Best Case Series Program, and CAM practitioners’ level of interest in research collaboration with CAM researchers. A cross-sectional survey of a convenience sample of cancer CAM practitioners was conducted. One hundred thirty-four respondents completed the survey. About 72% of the respondents were involved in the care of cancer patients, and these were considered the informative respondents. All results were from the informative respondent group. Respondent practitioners provided care using interventions from all seven of the predefined CAM categories. This care was provided to improve both quality of life and survival. Over two-thirds of the respondents rated research in pharmacologic and biologic treatments, alternative medical systems and nutritional therapeutics for cancer treatment, and symptom/side-effect management as high-priority areas. Although no single obstacle to research predominated as the most significant, the most frequently encountered obstacle was lack of awareness of appropriate funding sources (75.4%). More than 83% of respondents expressed some interest in or willingness to establish research collaboration with a cancer researcher. The results from this survey indicate that many cancer CAM practitioners have shared interests, perceived obstacles, and desired research opportunities. Despite a small sample size and lack of a feasible process for random sampling, this survey highlights avenues to promote and support collaborative research. The NCI/Office of Cancer Complementary and Alternative Medicine will continue to respond to the concerns elucidated by the survey by developing strategies for future program opportunities within the NCI.
cancer complementary and alternative medicine practitioners; complementary and alternative medicine (CAM); practitioner survey
To examine personal use of complementary and alternative medicine (CAM) among U.S. health care workers.
Data are from the 2007 Alternative Health Supplement of the National Health Interview Survey. We examined a nationally representative sample of employed adults (n = 14,329), including a subsample employed in hospitals or ambulatory care settings (n = 1,280).
We used multivariate logistic regression to estimate the odds of past year CAM use.
Health care workers are more likely than the general population to use CAM. Among health care workers, health care providers are more likely to use CAM than other occupations.
Personal CAM use by health care workers may influence the integration of CAM with conventional health care delivery. Future research on the effects of personal CAM use by health care workers is therefore warranted.
Complementary and alternative medicine; health care workforce; National Health Interview Survey
Background. Although studies have shown that the use of complementary and alternative medicine (CAM) is common in cancer patients, few surveys have assessed CAM use and associated factors in various cancers in Korea. Objectives. We explored factors predicting CAM use among a nationally representative sample of cancer patients. Methods. In total, 2,661 cancer patients were administered questionnaires about their CAM use and factors that might predict CAM use including sociodemographics, clinical and quality-of-life factors, time since diagnosis, trust in physicians, trust in hospitals, satisfaction, and informational needs. Data were analyzed using Pearson's χ2
tests and multivariate logistic regression analysis. Results. Overall, 25.5% reported that they had used or were using CAM. Higher income, presence of metastasis, longer time since diagnosis, less trust in hospitals, lower overall satisfaction, and higher degree of informational need were significantly associated with CAM use. Conclusions. The use of CAM in patients with cancer can be interpreted as an attempt to explore all possible options, expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.
Use of complementary and alternative medicine (CAM) is prevalent among HIV+ individuals despite the success of antiretroviral treatments and limited evidence of CAM's safety and efficacy. To characterize the potential impact of CAM use on HIV care, we conducted a systematic review of 40 studies of CAM use among HIV+ people. The goals of this review are to: (a) describe the demographic, biomedical, psychosocial, and health behavior correlates of CAM use; (b) characterize patient-reported reasons for CAM use; and (c) identify methodological and conceptual limitations of the reviewed studies. Findings confirm that a high proportion of HIV+ individuals report CAM use (M = 60%). Overall, CAM use is more common among HIV+ individuals who are men who have sex with men (MSM), non-minority, better educated, and less impoverished. CAM use is also associated with greater HIV symptom severity and longer disease duration. HIV+ CAM users commonly report that they use CAM to prevent or alleviate HIV-related symptoms, reduce treatment side-effects, and improve quality of life. Findings regarding the association between CAM use, psychosocial adjustment, and adherence to conventional HIV medications are mixed. While the reviewed studies are instrumental in describing the characteristics of HIV+ CAM users, this literature lacks a conceptual framework to identify causal factors involved in the decision to use CAM or explain implications of CAM use for conventional HIV care. To address this concern, we propose the use of health behavior theory and discuss implications of review findings for HIV care providers.
Although racial/ethnic differences in the prevalence of complementary and alternative medicine (CAM) utilization have been documented, differences in the reasons for using CAM have not been empirically assessed. In an increasingly diverse society, understanding differences in rates of and reasons for CAM use could elucidate cultural and social factors of health behaviors and inform health care improvements. The current study examines reasons for CAM use among women in four racial/ethnic groups.
A national telephone survey of 3172 women aged 18 years and older was conducted in four languages. Respondents were asked about their use of remedies or treatments not typically prescribed by a medical doctor. This study focuses on those women who used CAM in the previous year and their reasons for using CAM.
Non-Hispanic white women were most likely to cite personal beliefs for CAM use. Cost of conventional medicine was most prevalent among Mexican-American women CAM users. Physician referral, family and friends, and media sources were all equally likely to lead to CAM use in non-Hispanic white women. In contrast, informal networks of family and friends were the most important social influences of CAM use among African-, Mexican-, and Chinese-American women.
Racial/ethnic differences in reasons for CAM use highlight cultural and social factors that are important to consider in public evaluation of the risks and benefits of CAM remedies and treatments.
There is evidence that complementary and alternative medicine (CAM) use is common among people with diabetes. The role of CAM in the treatment or management of diabetes is an emerging health issue given the potential side effects and benefits associated with the use of this kind of medicine. This paper examined patterns and determinants of CAM practitioner use in Queensland, Australia, using a large population-based sample of people with type 1 and type 2 diabetes. The study found that within a 12-month period, 7.7% of people with diabetes used the services of CAM practitioners alongside or as a complement to conventional health care service. Younger age, female gender, a higher education, having private health insurance, and engagement in preventive health behaviours are significant predictors of individuals who are more likely to visit a CAM practitioner. There was no significant difference in CAM practitioner use between people with type 1, type 2 insulin requiring, or type 2 noninsulin requiring diabetes. The findings highlight the need for further research on the role of CAM in the prevention and management of diabetes.
Despite the high prevalence of Complementary and Alternative Medicine (CAM) product use among the elderly, little is known about the extent of concurrent CAM-conventional medicine use and the potential for adverse reactions.
To determine the prevalence of CAM product use concurrent with conventional medications, prescription and non-prescription, in a Medicare population and to assess the risk for adverse interactions.
Retrospective analysis was performed on Cardiovascular Health Study interview data from 1994, 1995, 1997, and 1999. The prevalence of concurrent combinations of CAM products and conventional drugs was tabulated. The adverse interaction risk was categorized as unknown, theoretical, and significant.
Of 5,052 participants the median age was 75; 60.2% were female; 16.6% African-American; and 83.4% white. The percent using CAM products during the four time periods was 6.3, 6.7, 12.8 and 15.1. The percent using both CAM products and conventional drugs was 6.0, 6.2, 11.7 and 14.4. Of these, 294 individuals (5.8%) took combinations considered to have a significant risk for an adverse interaction. Combinations with risk were observed on 393 separate interviews. Most (379) involved a risk of bleeding due to use of ginkgo, garlic or ginseng together with aspirin, warfarin, ticlopidine or pentoxifylline. An additional 786 observations of combinations were considered to have some, albeit theoretical or uncertain, risk for an adverse interaction.
Concurrent use of CAM products and conventional medicines in a Medicare population was common. Research to define the risks of combining ginkgo and garlic supplements with aspirin should be of high priority.
Interactions; herbal; elderly; garlic; ginkgo; ginseng; St. John’s wort
Although previous national surveys have shown an increase in the use of complementary and alternative medicine (CAM) in the U.S. population, racial and ethnic minority populations were under-represented in these surveys. As a result, a profile of the CAM user as white, female, affluent, middle-aged and well educated has emerged. Representing the mainstream population, these previous studies did not take into account the racial and ethnic minority populations who may have their own healing traditions and who may hold different beliefs, use different terminology, and have unique patterns of CAM use. In partnership with community-based organizations and community residents, a culturally sensitive survey instrument and protocols were designed and tested to gather data on lower income, urban African-Americans' use of, attitudes toward, and understanding of CAM. The major findings of this pilot research are 1.) Community-partnered research can help researchers gain access to sensitive data and design culturally appropriate studies; 2.) CAM terminology varies by cultural group; 3.) Certain forms of CAM (folk or family practices) are commonly found in African-American populations; and 4.) Factors that affect CAM use--including age, lack of access to conventional medicine, cultural heritage, and dissatisfaction with conventional medicine.
This study seeks to examine the correlates of complementary and alternative medicine (CAM) use in depressed underserved minority populations receiving medical care in primary care settings.
A prospective study using interviewer-administered surveys and medical record reviews was conducted at 2 large outpatient primary care clinics providing care primarily to underserved African American and Hispanic individuals located in Los Angeles, California. A total of 2321 patients were screened for depression. Of these, 315 met the Patient Health Questionnaire-9 criteria for mild to severe depression.
Over 57% of the sample reported using CAM sometimes or often (24%) and frequently (33%) for treatment of their depressive symptoms. Controlling for demographic characteristics, lack of health care coverage remained one of the strongest predictors of CAM use. Additionally, being moderately depressed, using psychotherapeutic prescription medications, and poorer self-reported health status were all associated with increased frequency of CAM utilization for treating depression.
The underserved African American and Hispanic individuals meeting the diagnostic criteria for depression or subsyndromal depression use CAM extensively for symptoms of depression. CAM is used as a substitute for conventional care when access to care is not available or limited. Since CAM is used so extensively for depression, understanding domains, types, and correlates of such use is imperative. This knowledge could be used to design interventions aimed at improving care for depression.
Complementary and alternative medicine (CAM) use is widespread among cancer patients. Information on safety and efficacy of CAM therapies is needed for both patients and health care providers. Well-designed randomized clinical trials (RCTs) of CAM therapy interventions can inform both clinical research and practice.
To review important issues that affect the design of RCTs for CAM interventions.
Using the methods component of the Consolidated Standards for Reporting Trials (CONSORT) as a guiding framework, and a National Cancer Institute-funded reflexology study as an exemplar, methodological issues related to participants, intervention, objectives, outcomes, sample size, randomization, blinding, and statistical methods were reviewed.
Trials of CAM interventions designed and implemented according to appropriate methodological standards will facilitate the needed scientific rigor in CAM research. Interventions in CAM can be tested using proposed methodology, and the results of testing will inform nursing practice in providing safe and effective supportive care and improving the well-being of patients.
complementary and alternative therapies; methodology
To determine predictors of complementary and alternative medicine (CAM) use, we used a cohort of 1,445 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.
CAM use; elderly; Mexican Americans; Medicaid; religiosity; acculturation
Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women.
A nationally representative telephone survey of 808 women ≥18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain—spirituality, religion, or prayer for health—during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use.
Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions.
Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.