Use of conventional care and complementary/alternative medicine among US adults with arthritis

Objective

Managing arthritis and co-morbid conditions is of public health importance. It is therefore critical to have a comprehensive understanding of healthcare utilization among US adults with arthritis. Thus, the present study identified characteristics associated with using both complementary and alternative medicine (CAM) and conventional healthcare.

Method

Using 2007 National Health Interview Survey data, multinomial logistic regression was performed to compare four categories of past year healthcare use (both CAM and conventional care vs. conventional care only, CAM only, and no healthcare use) on their potential correlates.

Results

The sample (n = 3850) was 62.8% female and 80.4% non-Hispanic White. Nearly half were at least 65 years old, and had used both CAM and conventional services in the previous year. The following characteristics were associated with having used neither CAM nor conventional care in the previous year (vs. having used both CAM and conventional care): being from an ethnic and racial minority group (ORs = 2.44, 3.26, and 3.91) and being uninsured (OR = 4.06), identifying individuals potentially at risk for unmet need.

Conclusion

To ensure access to comprehensive care, potentially underserved populations should be targeted with outreach (e.g., providing low-cost, accessible care, and education about benefits of various treatments for arthritis and co-morbid conditions).     

Insurance covered and non-covered complementary and alternative medicine utilisation among adults in Taiwan

Complementary and alternative medicine (CAM) has been characterized by prevalence, cost, and patterns of use. Factors determining its utilization have also been analyzed, either generally or for specific diseases, but few studies have considered the determinants of its frequency of use. Taiwan's pluralistic health care system and comprehensive insurance program covering Western medicine and traditional Chinese medicine (TCM) provide an interesting case to explore what forms of CAM people use, why and how often they use them. By using Taiwan's 2001 National Health Interview Survey and linking it with National Health Insurance (NHI) claims data, this study aims to investigate the socio-demographic, economic, behavioral and health determinants of use and frequency of use for both non-covered and covered CAM in Taiwan. The former consists of services practiced by non-regulated or non-NHI contracted practitioners and the latter includes those TCM covered by NHI. Our study showed that the determinants of using non-covered and covered CAM differ with respect to socio-demographic and behavioral factors, and health needs. Our evidence suggests that future CAM research must delineate between use and frequency of use to better understand the underlying factors contributing to initiation and continuity of CAM use.     

Acculturation and the use of complementary and alternative medicine

The use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.     

Health need and the use of alternative medicine among adults who do not use conventional medicine

Background  

We hypothesize that a substantial portion of individuals who forgo conventional care in a given year turn to some form of alternative medicine. This study also examines whether individuals who use only alternative medicine will differ substantially in health and sociodemographic status from individuals using neither alternative medicine nor conventional care in a given year. To identify those factors that predict alternative medicine use in those not using conventional care, we employed the socio-behavioral model of healthcare utilization.     

Self-reported short sleep duration among US adults by disability status and functional disability type: Results from the 2016 Behavioral Risk Factor Surveillance System

BackgroundShort sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities.ObjectiveTo examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged ≥18 years.MethodsData from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as <7 h per 24-h period. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for socioeconomic and health-related characteristics.ResultsAdults with any disability had a higher prevalence of short sleep duration than those without disability (43.8% vs. 31.6%; p < .001). After controlling for selected covariates, short sleep was most prevalent among adults with multiple disabilities (PR 1.40, 95% CI: 1.36–1.43), followed by adults with a single disability type (range: PR 1.13, 95% CI: 1.03–1.24 [for independent living disability] to PR 1.25, 95% CI: 1.21–1.30 [for mobility disability]) compared to adults without disability.ConclusionsPeople with disabilities had a higher likelihood of reporting short sleep duration than those without disabilities. Assessment of sleep duration may be an important component in the provision of medical care to people with disabilities.     

Beyond the barriers: racial discrimination and use of complementary and alternative medicine among Black Americans

This article examines whether self-reported racial discrimination is associated with greater use of complementary and alternative medicine (CAM) and assesses whether the effects of reported racial discrimination are specific to the setting in which the unfair treatment occurred (i.e., medical or nonmedical settings). Data were drawn from the National Survey of Midlife Development in the United States (MIDUS) of Black adults aged 25 and older at baseline (N=201). Analyses account for multiple forms of discrimination: major lifetime discriminatory events and everyday discrimination (more commonplace negative occurrences). Using logistic and negative binomial regression, results reveal that racial discrimination was associated with a higher likelihood of using any type of CAM as well as using more modalities of CAM. Also, both discrimination in health care and discrimination in nonmedical contexts predicted greater use of CAM. The findings underscore the tenet that health care choices, while influenced by health status and availability of health care resources, are also shaped by perceived barriers. The experience of racial discrimination among Black people is associated with greater use of alternative means of health care, as a way to cope with the barriers they experience in institutional settings in the United States.     

Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study

Objectives: The objectives of this study were to identify the prevalence of the use of vitamin/mineral supplements or natural/herbal remedies, concurrent use of pharmaceutical medication, and to profile those most likely to use these complementary and alternative medicines (CAM) in the treatment of five chronic conditions identified as national health priorities (asthma, diabetes, arthritis, osteoporosis, heart or circulatory condition) within the Australian adult population. Methods: Analysis of the Australian National Health Survey database, 2004–05. Results: Approximately 24% (1.3 million) of Australian adults with a chronic condition regularly applied CAM to treatment. CAM was most often used exclusively or in combination with pharmaceutical medicine in the treatment of arthritis and osteoporosis. Fewer than 10% of adults with asthma, diabetes or a heart or circulatory condition used CAM, most preferring pharmaceutical medicine. Regular CAM users were more likely to be aged ≥60, female, have a secondary school education and live in households with lower incomes than non‐users. Non‐users were more likely to be 30–59 years old and tertiary educated. Conclusion and implications: Arthritis, osteoporosis and, to a lesser extent, heart or circulatory conditions are illnesses for which doctors should advise, and patients need to be most aware about the full effects of CAM and possible interactive effects with prescribed medicine. They are also conditions for which research into the interactive effects of CAM and pharmaceutical medication would seem of most immediate benefit.     

Complementary and alternative medicine use among adults: United States, 2002

OBJECTIVE: This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults, using data from the 2002 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). METHODS: Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). This report is based on 31,044 interviews of adults age 18 years and over. Statistics shown in this report were age adjusted to the year 2000 U.S. standard population. RESULTS: Sixty-two percent of adults used some form of CAM therapy during the past 12 months when the definition of CAM therapy included prayer specifically for health reasons. When prayer specifically for health reasons was excluded from the definition, 36% of adults used some form of CAM therapy during the past 12 months. The 10 most commonly used CAM therapies during the past 12 months were use of prayer specifically for one's own health (43.0%), prayer by others for one's own health (24.4%), natural products (18.9%), deep breathing exercises (11.6%), participation in prayer group for one's own health (9.6%), meditation (7.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%), and diet-based therapies (3.5%). Use of CAM varies by sex, race, geographic region, health insurance status, use of cigarettes or alcohol, and hospitalization. CAM was most often used to treat back pain or back problems, head or chest colds, neck pain or neck problems, joint pain or stiffness, and anxiety or depression. Adults age 18 years or over who used CAM were more likely to do so because they believed that CAM combined with conventional medical treatments would help (54.9%) and/or they thought it would be interesting to try (50.1%). Most adults who have ever used CAM have used it within the past 12 months, although there is variation by CAM therapy.     

Use of complementary and alternative medicine among primary care patients

OBJECTIVE: Complementary and alternative medicine use is increasing worldwide, and the expenses are high while its effectiveness is still in debate. The aim of this survey was to evaluate the utilization of complementary and alternative medicine in Israel. METHOD: Four-hundred and eighty patients in two primary care clinics have participated in the survey and answered an anonymous questionnaire. RESULTS: Ninety patients (18.7%) have consulted an alternative medicine therapist at least once in the past. Both younger (0-19) and older (65 and older) age groups were associated with a low rate of complementary and alternative medicine utilization. In the adult population, an academic education was associated with a higher utilization rate. The most frequently used methods were homeopathy (34.6%) and reflexology (18.7 %). Musculo-skeletal (20.6%) and respiratory (15.9%) complaints were the most frequent causes for complementary and alternative medicine consultation. The subjective outcome of complementary and alternative medicine treatment was considered beneficial in almost half of the cases and partially beneficial in another 34.6%. CONCLUSIONS: Utilization of complementary and alternative medicine is as widespread in Israel as in other Western countries. Utilization rates were found to be associated with age and education but not with gender or origin.      

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.     

Pregnancy,risk perception and use of complementary and alternative medicine

Pregnancy and childbirth are events of major significance in women’s lives. In western countries women are increasingly using complementary and alternative medicine during this time. However, there is little research exploring the factors that are influential in women’s motivations to use complementary and alternative medicine during pregnancy and childbirth. This article draws on data from a narrative-based study designed to explore women’s experiences of complementary and alternative medicine use during pregnancy and childbirth. The study involved 14 women living in the South-west of England, who had used complementary and alternative medicine during pregnancy and childbirth. We elicited narratives by interviewing women two to three times. The women in our study used complementary and alternative medicine both as a response to the uncertainty of pregnancy and childbirth and as a defence against manufactured risk, and in doing so indicated their desire to transform an unpredictable and unmanageable future into one which is more predictable and manageable. It was a means of dealing with the stress and anxiety associated with uncertainty which has to be dealt with. Their consciousness of the risks of biomedicine developed though the practice of complementary and alternative medicine, and their high educational status and relative affluence facilitated their choices. There was a tension evident in their narratives between a need to ‘be in control’ versus a desire for a natural childbirth without medical intervention. Women in the study showed their autonomy by actively pursuing complementary and alternative medicine while at the same time selectively using expert medical knowledge.     

Sociocultural barriers to the use of complementary and alternative medicine for HIV

The author investigated sociocultural barriers that constrain use of complementary and alternative medicine (CAM) in the lives of people with HIV. Qualitative interviews with 62 persons with HIV revealed that 73% (n = 45) of interviewees were classified as potential users of CAM. These included both users and nonusers who expressed interests in using CAM or specific modalities but did not use. The demand for CAM was constrained to the extent that participants were unable to incorporate CAM into their health strategies. Three main CAM constraints dealt with obstacles stemming from the Culture of Medicine, the Social Organization of Alternative Medicine, and Everyday Life. From these constraints, the author drew conclusions about sociocultural factors that slow the diffusion of CAM into mainstream health practices.     

Association between use of complementary/alternative medicine and health-related behaviors among health fair participants.

BACKGROUND: The relationship between complementary and alternative medicine (CAM) and standard preventive care is not well defined. METHODS: We surveyed 1,593 health fair participants on their use of CAM and determined odds ratios for standard preventive care and healthy behaviors among users of provider-based CAM (e.g., chiropractic) and users of herbs or supplements. RESULTS: Users of provider-based CAM were no less likely than nonusers to receive standard preventive care, with the exception of lower likelihood of influenza vaccination among elderly CAM users (OR 0.2). Herbs or supplements were used by a majority of respondents (61%), and users were more likely to report engaging in healthy behaviors such as eating a low-fat diet (OR 1.5) and taking a daily multivitamin (OR 2.0). CONCLUSIONS: Those who use alternative therapies, including herbs or supplements, appear no less likely overall than nonusers to receive standard preventive care. In addition, users of herbs or supplements are more likely to engage in healthy behaviors and appear to be a more health-conscious group. Overall, our findings support the notion that unconventional therapies are more complementary than alternative to standard preventive care.     

Access to conventional medical care and the use of complementary and alternative medicine

The use of complementary and alternative medicine (CAM) in the United States has greatly increased during the past decade. Using survey data from the 2002 National Health Interview Survey (NHIS), we show that adults who did not get, or delayed, needed medical care because of cost in the prior twelve months were also more likely than all other adults to use CAM. Recent increases in CAM use could be the result of not only the desire for individual empowerment and patient dissatisfaction with conventional medicine, as has been claimed, but also of increases in the relative cost of conventional health care.     

Dietary supplement use by South Korean adults: Data from the national complementary and alternative medicine use survey (NCAMUS) in 2006

There has been little data on the prevalence of supplement use and the characteristics of the dietary supplement users in the Republic of Korea. This study presents the prevalence and the details of any dietary supplement use and the characteristics of the adults who use dietary supplements in the Republic of Korea. Between May 18 and June 16, 2006, nationwide and population-weighted personal interviews with 6,201 adult aged from 30 to 69 years were conducted and the final sample consisted of 3,000 people with a 49.8% response rate. We examined the prevalence and details of the use of dietary supplements and the characteristics of those who use the dietary supplement among adults. About sixty two percent of adults had taken any dietary supplement during the previous 12-month period in 2006. The most commonly reported dietary supplement was ginseng, followed by multivitamins, glucosamine, probiotics, and vitamin C. Female (versus male), an older age group, a higher family income, those living in metropolitan cities, those with marital experience, those with a higher level of education, and those having medical problems had a greater likelihood of reporting the use of any dietary supplements. The particular relationships differed depending on the type of supplement. The most Korean adults took one more dietary supplement and the dietary supplement users had different demographic and health characteristics compared to those of the nonusers. Research on diet supplements by the medical community is needed in the future.