The use of complementary and alternative medications by menopausal women in South East Queensland.

This study aimed to identify the prevalence and types of complementary and alternative medications (CAMs) used by women during menopause and explore potential associations between CAM use and menopausal symptoms. Analysis was undertaken with 886 randomly selected menopausal women aged 47-67 years who participated in a postal questionnaire on the menopause experience. The prevalence of CAM use was relatively high (82.5%), with nutrition most commonly cited (67%), followed by phytoestrogens (56%), herbal therapies (41%), and CAM medications (25%). Multivariate analysis adjusted for confounders revealed that women who consumed CAM medications were 17-23% more likely to report anxiety (p = .019) or vasomotor symptoms (p = .013). Women who used herbal therapies (p = .009) or phytoestrogens (p = .030) were 13-16% more likely to experience vasomotor symptoms. Women who used nutrition were 18% more likely to experience anxiety (p = .049). These results highlight the importance for health professionals to incorporate CAMs into their practice to better inform menopausal women of their treatment choices.     

Medical Pluralism of Chinese Women Living in the United States

This study provides national prevalence estimates for complementary and alternative (CAM) use, visits to doctors for health problems, and the effects of acculturation on health practices in Chinese women living in the United States. A national telephone survey of 3,172 women on their use of complementary and alternative medicine was conducted in 2001. This study focuses on a subsample of 804 Chinese-American women who were asked about health practices and service utilization. Interviews were conducted in Mandarin, Cantonese and English. Forty-one percent of Chinese-American women used some form of CAM in 2001. Socio-economic status, a common predictor of CAM use in other studies of the general population in the United States, did not predict use in this sample. Traditional Chinese medicine (TCM) is used across acculturation levels. As Chinese women adapt to American culture they tend to use a greater variety of healthcare practices and to adopt mainstream CAM practices, but they also continue to use TCM.     

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.     

Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: prevalence, associated factors, and effects of patient-clinician communication

OBJECTIVE: We examined the use of complementary and alternative medical (CAM) therapies among Chinese and Vietnamese Americans who had limited proficiency with the English language and explore the association between patient-clinician discussions about CAM therapy use and patient assessments of quality of care. METHODS: We surveyed Chinese and Vietnamese Americans who visited 11 community health centers in 8 major cities throughout the United States. RESULTS: Of the 4410 patients surveyed, 3258 (74%) returned completed questionnaires. Two thirds of respondents reported they had "ever used" some form of CAM therapy; however, only 7.6% of these patients had discussed their use of CAM therapies with clinicians. Among patients who had used CAM therapies during the week before their most recent visits, clinician-patient discussions about CAM therapy use were associated with better overall patient ratings of quality of care. CONCLUSION: Use of CAM therapies was common among Chinese and Vietnamese Americans who had limited proficiency with the English language. Although discussions about CAM therapy use with clinicians were uncommon, these discussions were associated with better ratings of quality of care.     

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.     

Disclosing complementary and alternative medicine use in the medical encounter: a qualitative study in women with breast cancer

BACKGROUND: Despite recent findings that patients who use complementary and alternative medicine (CAM) typically choose not to mention this to their physicians, little is known about the reasons for this lack of communication. Understanding the reasons for nondisclosure of CAM use is critical to improving physician-patient communication and patient care. METHODS: We are conducting a 5-year prospective cohort study consisting of 4 interview cycles. The multiethnic, population-based sample consists of 86 San Francisco residents with recently diagnosed breast cancer (response rate = 87%). Findings are determined using qualitative analysis of transcribed interviews. RESULTS: At initial contact, 72% of the participants were using at least 1 CAM therapy for breast cancer. Six months later, 65% of participants were using CAM. Of the women being treated by an alternative practitioner, 54% disclosed their CAM use to their physicians. Conversely, 94% discussed details of their biomedical treatments with their alternative practitioner. Reasons for not disclosing CAM use included anticipating the physician's disinterest, negative response, or unwillingness or inability to contribute useful information; the perception that the CAM therapies used were irrelevant to the biomedical treatment course; and the patients' views regarding the appropriate coordination of disparate healing strategies. CONCLUSIONS: Discussions of patients' CAM use are more poorly integrated into the medical encounter than discussions of biomedical treatment are with alternative practitioners. Patients' disclosure is often cautiously modulated, even by those who would welcome an open discussion with their physicians. Specific suggestions for discussing CAM use with patients are presented.     

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.     

Association of complementary and alternative medicine use,demographic factors,and perimenopausal symptoms in a multiethnic sample of women: the ENDOW study

Complementary and alternative medicine (CAM) use is common in the United States, particularly among middle-aged women for symptoms commonly reported during perimenopause. The study examined the relationship between women's report of perimenopausal symptoms and the use of CAM and socioeconomic or cultural factors. The prevalence of CAM use was 33%; approximately 94% reported use of CAM therapies and 23% used CAM practitioners. Those who used CAM were younger and better educated; more often they reported pelvic pain and painful intercourse. The only demographic factor to predict use of alternative medicine was education.     

Sex in Australia: homosexual experience and recent homosexual encounters

OBJECTIVE: To describe the prevalence and features of homosexual experience and recent homosexual encounters among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS: Overall, 8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives (p<0.001); these figures fell to 5.7% and 5.0% respectively (p=0.106) when non-genital sexual experience was excluded. 1.9% of men and 1.5% of women reported homosexual experience in the past year. Men who reported homosexual experience reported more same-sex partners than did women (means 31.6 and 3.2, p<0.001), and men and women who identified as homosexual or bisexual reported more sexual partners in total than those who identified as heterosexual. Respondents reporting homosexual experience were significantly more likely to be from an English-speaking background, have higher levels of education, live in a major city, and report a white-collar or managerial/professional occupation. Women who reported homosexual experience were less likely to have a middle or high income. In the most recent homosexual encounter, genital touching was the most commonly reported practice, and oral sex was reported much more frequently than in heterosexual encounters. CONCLUSION: Homosexually and bisexually identified men and women had higher total numbers of partners than heterosexuals. Improved societal attitudes towards homosexuality are likely to lead to further increases in estimates of the prevalence of homosexual experience in the community.     

Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.     

Use of sexual health services among American Indian and Alaska Native Women

Because use of sexual health services among American Indian/Alaska Native women is understudied we: (1) examined disparities in use of sexual health services between American Indian/Alaska Native and non-Hispanic white women and (2) identified factors associated with service use among American Indian/Alaska Native women. We used data from the National Survey of Family Growth regarding the use of sexual health services collected between 2006 and 2010 from women aged 15–44 years who self-identified as American Indian/Alaska Native (n = 819) and white (n = 6,196). Weighted logistic regression models estimated the likelihood of reporting the use of sexual health services by race and factors associated with use in the American Indian/Alaska Native sample. Compared to whites, American Indian/Alaska Native women were less likely to use birth control services and more likely to use services for sexually transmitted diseases and HIV. Among American Indian/Alaska Natives, younger women were more likely to use birth control services, and women who had a higher number of sexual partners were more likely to use services for sexually transmitted diseases and HIV. Our results provide a national baseline against which to assess disparities and changes in the use of sexual health services among American Indian/Alaska Native women over time.     

Role of Gender,Insurance Status and Culture in Attitudes and Health Behavior in a US Chinese Student Population

Introduction Asians are an understudied population in health research. Often their lower utilization of health care services and low participation in clinical trials has been attributed to socioeconomic factors and cultural beliefs. However, the role of gender and perceptions of health beliefs across generations in determining access have not been studied in this population. Objective This study seeks to examine the relationship of gender to the health beliefs and health utilization patterns of a group of undergraduate Chinese students in regard to their own use and what they perceived as their parents' use. Design Seventy-eight Chinese students responded to a health belief and utilization survey. They were asked to provide information on their perceptions and attitudes of health as well as what they perceived to be their parents' health attitudes and behavior. Results. Findings indicated that female students were more proactive in their health beliefs towards preventive care and getting regular check-ups than male students. This difference between genders remained true in the students' perceptions of their mothers being more likely to seek preventive care and to get regular check-ups than their fathers. Cultural factors including privacy and modesty were important factors in determining use of health care by Chinese women. Insurance status played an important role in determining health behavior among Chinese men. Uninsured fathers were perceived as more likely to use complementary and alternative therapies (CAM) than mothers. Male students and fathers who had private insurance were perceived to access and utilize health services equally as the women. Gender differences are seemingly less apparent among parents who are using CAM. Language difficulty was identified most frequently as the major barrier to accessing care among this population. Conclusions Considerations of socioeconomic factors, cultural and language barriers need to be made with particular focus on gender differences in attitudes and health behavior when making policy decisions for the Asian American population. Further studies are also needed on intergenerational attitudes and health behavior of older Asian Americans.     

Use of and Attitudes Toward Complementary and Alternative Medicine Among Family Practice Patients in Small Rural Illinois Communities

CONTEXT: Complementary and alternative medicine (CAM) use continues to increase in the United States. Data on rural patients' use and extent of integration of CAM with conventional medicine are lacking, although this is a population often associated with use of "folk remedies" and self-care strategies. PURPOSE: To examine rural primary care patients' attitudes toward and use of CAM. METHODS: A total of 176 surveys (70% response rate) were returned by patients at 5 geographically dispersed, rural Illinois family practice clinics to examine rural patients' use of, attitudes toward, and experiences with alternative medicine and providers. FINDINGS: Nearly two thirds of patients reported use of alternative medicine. Therapies most often used were vitamins/megavitamins, chiropractic, relaxation, and prayer/faith healing. Rural patients with more medical problems and a higher level of education were more likely to use alternative techniques. Three fifths of the patients felt that their doctor should discuss alternative medicine and therapies with them. CONCLUSIONS: Physician understanding and communication regarding CAM may be especially important in rural areas, where access to care is more limited and where there is greater reliance on the primary care physician as a "gatekeeper" for patient health.     

Lactational Amenorrhea Method as a Contraceptive Strategy in Niger

If used properly, the lactational amenorrhea method (LAM) can be a valuable family planning tool, particularly in low-income countries; however, the degree to which LAM is used correctly and characteristics associated with its use have not been well documented. We therefore sought to use nationally representative data from Niger, where fertility rates are high and women may have limited access to alternative contraceptive methods, to describe the proportion of women who use LAM correctly and the characteristics associated with LAM use. We utilized cross-sectional data from the 2006 Niger Demographic Health Survey. Our sample included all sexually active, non-pregnant, breastfeeding women using some form of contraception (N = 673, unweighted). We used weighted frequencies to describe the correct use of LAM and logistic regression models to describe women who chose LAM for contraception. Among our sample, 52 % reported LAM as their primary method of contraception, but only 21 % of the women who reported using LAM used it correctly. Women who reported using LAM were more likely to live in certain regions of the country, to have no formal education, and to have delivered their most recent baby at home. They were also less likely to have discussed family planning at a health facility or with their husband/partner in the past year. Results indicated that few women in Niger who reported using LAM used it correctly. Our findings reinforce the need to address this knowledge gap, especially given Niger’s high fertility rate, and may inform efforts to improve family planning in Niger and in other low-income countries.     

Age-related differences in the conventional health care-complementary and alternative medicine link

Objective: To determine if differences in conventional care among users and nonusers distinct CAM therapies varies by age and ethnicity. Methods: The 2002 National Health Interview Survey data with a supplemental section on CAM use were analyzed. Results: The odds of reporting each level of conventional care were greater for CAM users than nonusers for each type of CAM. There is consistent evidence that associations between CAM and conventional care use differ by age but not ethnicity. Conclusions: Individuals who use CAM are greater users of conventional care, although these associations hold primarily for young and middle-aged adults. Results suggest that, for most CAM users, these therapies are not being used in place of conventional health care.     

Contraceptive use during lactation in developing countries

Contraceptive use by breastfeeding women in developing countries has led to concern about potentially harmful effects of steroid contraceptives on the health of breastfed children. In this paper, breastfeeding women's use of the pill and hormonal injections is investigated using survey data from 17 Latin American, Asian, and African countries. The results indicate that while the proportions of breastfeeding women who use these methods were small in most countries at the time of the surveys, the proportion using the pill was not inconsequential. In general, younger lactating women with higher education and more live births who live in urban areas are more likely to use the pill than other breastfeeding women.     

Prevalence of violence and its implications for women's health.

This study estimates the lifetime prevalence of violent experiences and their relationship to health and the use of health services in U.S. women aged 18-64 years. The Commonwealth Fund's 1998 Survey of Women's Health provides a nationally representative sample. Use of weighted data allows projections to be made to the U.S. population. Over four of ten women in the U.S. are likely to have experienced one or more forms of violence, including child abuse (17.8%), physical assault (19.1%), rape (20.4%), and intimate partner violence (34.6%). In multivariate logistic regression models that control for sociodemographic characteristics, violence-particularly intimate sexual violence-is significantly related to poorer physical and mental health and increased problems with access to medical care. Only one-third of women who experience violence have discussed it with a physician. Health care professionals need to initiate the conversation about violence and offer referrals for needed services.     

How Does Acculturation Affect the Use of Complementary and Alternative Medicine Providers Among Mexican- and Asian- Americans?

Researchers have found that immigrants in the United States gradually relinquish cultural practices and adopt health behaviors similar to native born individuals as they acculturate. Few studies have looked at acculturation and Complementary and Alternative Medicine (CAM) use, particularly ethnic forms of CAM. This study uses data from the 2001 California Health Interview Survey—Complementary and Alternative Medicine (CHIS-CAM) supplement to estimate the prevalence of CAM provider use among Mexican- and Asian- Americans and examine the relationship of acculturation on use. Multinomial logistic regression models were used to predict the probability of provider use based on socio-demographic variables, health status and acculturation. Mexican- and Asian- Americans who have spent more time in the US were more likely to use chiropractors or massage therapists compared to no CAM provider. Both groups were less likely to use ethnic-specific CAM providers with more time in the US compared to chiropractors or massage therapists.