Health behaviors and utilization among users of complementary and alternative medicine for treatment versus health promotion

Objective. To compare the characteristics, health behaviors, and health services utilization of U.S. adults who use complementary and alternative medicine (CAM) to treat illness to those who use CAM for health promotion. Data Source. The 2007 National Health Interview Survey (NHIS). Study Design. We compared adult (age ≥18 years) NHIS respondents based on whether they used CAM in the prior year to treat an illness (n=973), for health promotion (n=3,281), or for both purposes (n=3,031). We used complex survey design methods to make national estimates and examine respondents' self‐reported health status, health behaviors, and conventional health services utilization. Principal Findings. Adults who used CAM for health promotion reported significantly better health status and healthier behaviors overall (higher rates of physical activity and lower rates of obesity) than those who used CAM as treatment. While CAM Users in general had higher rates of conventional health services utilization than those who did not use CAM; adults who used CAM as treatment consumed considerably more conventional health services than those who used it for health promotion. Conclusion. This study suggests that there are two distinct types of CAM User that must be considered in future health services research and policy decisions.     

Predictors of prostate cancer screening among health fair participants

OBJECTIVES: Most previous studies of predictors for participation in prostate-specific antigen (PSA) screening for prostate cancer have been conducted in purposive samples or clinical settings. This population-based study identified factors associated with documented PSA screening among health fair participants. STUDY DESIGN: Cross-sectional survey of 2098 Nebraskan men aged 35 years and older who participated in a health fair in central and eastern Nebraska in 1993. METHODS: All participants were offered a PSA screening and a questionnaire to collect information on demographics, family medical history, lifestyle factors and self-perceived health status. Predictors of PSA screening were estimated by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Men were more likely to accept the PSA screening if they were older than 50 years of age (OR=3.1; 2.4-3.9), had a higher income (OR=1.5; 1.1-2.1), were currently employed (OR=1.4; 1.0-2.5), perceived their health status as good (OR=1.1; 0.8-1.5) or excellent (OR=1.4; 1.0-2.1), and believed that they themselves, rather than physicians, should be responsible for their health (OR=1.3; 1.0-1.7). Compared with men aged 50-59 years, the ORs of participation were 0.8 (0.6-1.1) for age 60-69 years and 0.7 (0.5-1.1) for age 70+ years. Decision making was not related to education, marital status or body mass index. Predictors of screening remained unchanged when analysis was limited to men aged 50 years and over, whereas only high income and non-smoking status predicted participation among men younger than 50 years of age. CONCLUSIONS: Age, income, employment status, perceived control of health and perceived heath status were related to participation in PSA screening for prostate cancer, particularly in men older than 50 years of age. Willingness to receive a PSA screening among men aged 50 years and over decreased with increasing age.     

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.     

Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants

OBJECTIVES: We estimated the prevalence and longitudinal correlates of use of complementary and alternative medicine (CAM) at midlife among participants of the Study of Women's Health Across the Nation (SWAN). METHODS: Multiple logistic regression was used to evaluate the relationship between baseline survey-reported symptoms and use of herbal, spiritual, and physical manipulation therapies 1 year later. RESULTS: Almost half of all women had used CAM in the past year. Baseline psychological symptoms were associated with subsequent use of spiritual therapies among White and Chinese women. Baseline CAM use was a major predictor of subsequent use in White, Japanese, and Chinese women. CONCLUSIONS: Baseline CAM use, rather than presence of symptoms, was the major predictor of subsequent CAM use. Premenopausal health behaviors are important determinants of choice of therapy during midlife.     

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.     

The health beliefs of health fair participants

The motivations and health beliefs of adults who participate in community-based health promotion were studied through a survey of 303 adults attending five community health fairs. Subjects were predominately female (69.9%), over age 60 (66.8%), and had at least yearly contact with a family physician (85.3%). Obtaining laboratory testing services was the sole reason for attendance for 47% of participants, was thought to be of much greater importance than health educational materials also offered at the health fair, and identified as providing a sense of control over personal health care. Receiving their own normal test results was perceived as assuring a healthy future for 86% of participants and few used these results to support erroneous health beliefs. A theme of positive health feedback, identified through factor analysis of survey responses, may prove useful for family physicians to incorporate into more directed and useful health promotion efforts for enhanced patient participation and satisfaction.John M. Heath, MD is Research Assistant Professor Department of Family Medicine, State University of New York Health Science Center at Syracuse. Karen S. Lucic, BSc is a Research Assistant, University of Cincinnati. David Hollifield, BS was a Medical Student, University of Cincinnati. John R. Kues, PhD is Assistant Professor, Department of Family Medicine, University of Cincinnati.This research was conducted during the senior author's faculty development fellowship training at the University of Cincinnati Department of Family Medicine and supported in part by US Dept. H.H.S. Grant #PE85025.     

Prevalence of use of complementary/alternative medicine: a systematic review

Reported are the results of a systematic review of the prevalence of use of complementary/alternative medicine. Computerized literature searches were carried out in four databases. Twelve surveys thus found were selected because they dealt with the utilization of complementary/alternative medicine in random or representative samples of the general population. Data were extracted in a predefined, standardized way. Prevalence of use of complementary/alternative medicine ranged from 9% to 65%. Even for a given form of treatment such as chiropractic, as used in the USA, considerable discrepancies emerged. The data suggest that complementary/alternative therapies are used frequently and increasingly. Prevalence of use seemed to depend critically on factors that were poorly controlled in surveys of complementary/alternative medicine. The true prevalence of use of complementary/alternative medicine in the general population remains uncertain.     

Association between exercise and other preventive health behaviors among diabetics

Two hundred and seventy patients were studied to investigate the cross sectional association between exercise and other preventive health behaviors in a diabetic population. Patients included both insulin and noninsulin dependent diabetics and were recruited from the Family Practice and Pediatrics Clinics at Bowman Gray School of Medicine. During screening, patients underwent a physical examination as well as completing a survey to assess exercise and health behavior habits. Three exercise groups were compared: (a) patients who expended more than 600 kilocalories per week during exercise, (b) patients who expended 600 kilocalories or less, and (c) patients who did not exercise. The mean body weights of both exercise groups were found to be less than the nonexercise group, and the heavy exercise group also had a lower mean body mass index. Heavy exercisers reported greater caloric intakes than both moderate and nonexercisers. There were no differences found concerning the composition of their diets among groups. The heavy exercise group reported wearing their seatbelts a greater percentage of the time and visited the dentist more often compared with the sedentary group. There were no significant differences found among exercise groups concerning blood sugar monitoring, alcohol consumption, smoking, or in obtaining periodic health examinations. It was concluded that exercise was associated with several, but not a majority, of other healthful behaviors in a population of diabetics.     

Spiritual and religious identities predict the use of complementary and alternative medicine among US adults

Objective

To determine whether spiritual and religious identities predict complementary and alternative medicine (CAM) use above and beyond other known influences such as gender, region of residence, social status, personality, health, and access to conventional medicine.

Methods

Analyzing data from the 1995-1996 National Survey of Midlife Development in the United States (n = 3032), this study examines the correlations between four aspects of spirituality/religiousness—i.e., spiritual only, religious only, both spiritual and religious, and neither spiritual nor religious—and six measures of CAM.

Results

Compared with spiritual only persons, the odds of using energy therapies are 86% lower for spiritual and religious persons, 65% lower for religious only persons, and 52% lower for neither spiritual nor religious persons. Compared to spiritual only persons, spiritual and religious individuals are 43% more likely to use body-mind therapies in general; however, when this category does not contain prayer, meditation, or spiritual healing, they are 44% less likely. Religious only individuals are disinclined toward CAM use.

Conclusions

After controlling for established predictors including educational attainment, personality, social support, and access to conventional medicine, the present study demonstrates that spirituality and religiousness are associated, in unique ways, with CAM use. Additional research on this topic is clearly warranted.     

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.      

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.     

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).     

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.     

大学生心理控制源与健康危险行为的关系

目的 探索心理控制源对大学生健康危险行为的影响,为制定大学生健康危险行为干预措施提供参考依据.方法 采用多阶段整群随机抽样方法,从中国东部、中部和西部地区分别随机抽取2个省份,每个省份随机抽取2所高校,对来自12所高校的3951名大学生完成在线匿名调查,内容包括人口学特征、心理控制源量表和大学生健康危险行为问卷.采用x...     

大学生儿童期虐待经历与健康危险行为的关系

目的 了解大学生健康危险行为发生现状及其与儿童期虐待经历的关系,为预防儿童虐待和健康危险行为的发生提供参考.方法 于2016年3-4月,采用整群抽样的方法对南充市2所高校918名大学生进行匿名问卷调查,调查内容包括一般人口学特征、儿童期虐待经历及健康危险行为.使用x2检验进行单因素分析,使用Logistic回归进行多因...     

The use of selected nutrition supplements and complementary and alternative medicine in liver disease.

Almost all patients with liver disease, especially advanced liver disease, have some evidence of malnutrition, including mineral/vitamin deficiency. A major health trend in the United States has been the significant growth in the use of complementary and alternative medicine (CAM), including nutrition supplements and herbal agents. In the 1990s, the United States government created the National Center for Complementary and Alternative Medicine (NCCAM), as well as the Office on Dietary Supplements, to extend our knowledge in these areas. CAM users are often highly educated and frequently use CAM therapy for chronic diseases, including chronic liver disease. Indeed, most studies suggest that patients with chronic liver disease frequently use nutrition supplements and CAM agents in addition to their traditional medicines. The purpose of this review is to provide an update on the role of nutrition supplements and herbals in liver disease. This article will focus mainly on 7 selected agents (vitamin E, zinc, magnesium, S-adenosylmethionine, betaine, silymarin, and glycyrrhizin), for which there have been not only in vitro and animal studies but also human clinical trials, and we will review both potential efficacy and safety issues.