Use of complementary and alternative medicine among women in New York City: a pilot study

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

BACKGROUND

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

OBJECTIVE

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

SEARCH STRATEGY

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

INCLUSION CRITERIA

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

DATA EXTRACTION AND ANALYSIS

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

RESULTS

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

CONCLUSION

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

Use and attitudes toward complementary and alternative medicine among university students: The role of gender and race

Purpose: This study assessed gender, race, use of complementary and alternative medicine (CAM), attitudes toward CAM, and disclosure of CAM use to health providers using an online survey of 506 students at a regional public university. Methods: Ordinary least squares regression models were used to examine relationships of interest, including use, attitudes, and disclosure of CAM by self-identified gender and race. Results: The most common therapy reported included vitamins and mineral supplements, and participants of all racial and gender identities expressed generally positive attitudes toward CAM. Women reported using CAM significantly more often than men, and Whites more often than non-Whites. Conclusions: White respondents were more likely to disclose the use of CAM to healthcare providers compared to African American respondents, and women reported disclosure more often than men. A significant interaction between gender and race was noted for attitudes toward CAM for Whites and African Americans, with White women most positive toward CAM.

The Herb-Drug Pharmacokinetic Interaction of 5-Fluorouracil and Its Metabolite 5-Fluoro-5,6-Dihydrouracil with a Traditional Chinese Medicine in Rats

Background: Xiang-Sha-Liu-Jun-Zi-Tang (XSLJZT) is the most common traditional formula given to colorectal and breast cancer patients in Taiwan, according to a statistical study of the National Health Insurance Research Database. 5-Fluorouracil (5-FU) is widely used as the first line of treatment for colorectal cancer. Thus, the aim of study is to investigate the pharmacokinetic interaction of XSLJZT and 5-FU. Methods: To investigate the herb–drug interaction of XSLJZT with 5-FU as well as its metabolite 5-fluoro-5,6-dihydrouracil (5-FDHU) using pharmacokinetics, a high-performance liquid chromatography (HPLC) system coupled with a photodiode array detector was developed to monitor 5-FU and 5-FDHU levels in rat blood. Rats were divided into three cohorts, one of which was administered 5-FU (100 mg/kg, iv—intravenous) alone, while the other two groups were pretreated with low and high doses of XSLJZT (600 mg/kg/day or 2400 mg/kg/day for 5 consecutive days) in combination with 5-FU. Results: The results demonstrated that 5-FU level was not significantly different between the group treated with only 5-FU and the group pretreated with a normal dose of XSLJZT (600 mg/kg/day). However, pharmacokinetic analysis revealed that pretreatment with a high dose of XSLJZT (2400 mg/kg/day) extended the residence time and increased the volume of distribution of 5-FU. No significant distinctions were found in 5-FDHU pharmacokinetic parameters at three doses of XSLJZT. Conclusions: Overall, the pharmacokinetic results confirm the safety of coadministering 5-FU with XSLJZT, and provide practical dosage information for clinical practice.

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

Background

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

Methods

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

Results

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

Conclusions

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

Prevalence of Complementary and Alternative Medicine and Herbal Remedy Use in Hispanic and Non-Hispanic White Women: Results from the Study of Women's Health Across the Nation

OBJECTIVES

To investigate the prevalence of complementary and alternative medicine (CAM) use, including botanical/herbal remedies, among Hispanic and non-Hispanic white women from the Study of Women's Health Across the Nation (SWAN), New Jersey site. We also examined whether attitudes toward CAM and communication of its use to providers differed for Hispanic and non-Hispanic women.

STUDY DESIGN

SWAN is a community-based, multiethnic cohort study of midlife women. At the 13th SWAN follow-up, women at the New Jersey site completed both a general CAM questionnaire and a culturally sensitive CAM questionnaire designed to capture herbal products commonly used in Hispanic/Latina communities. Prevalence of and attitudes toward CAM use were compared by race/ethnicity and demographic characteristics.

RESULTS

Among 171 women (average age 61.8 years), the overall prevalence of herbal remedy use was high in both Hispanic and non-Hispanic white women (88.8% Hispanic and 81.3% non-Hispanic white), and prayer and herbal teas were the most common modalities used. Women reported the use of multiple herbal modalities (mean 6.6 for Hispanic and 4.0 for non-Hispanic white women; p = 0.001). Hispanic women were less likely to consider herbal treatment drugs (16% vs. 37.5%; p = 0.005) and were less likely to report sharing the use of herbal remedies with their doctors (14.4% Hispanic vs. 34% non-Hispanic white; p = 0.001). The number of modalities used was similar regardless of the number of prescription medications used.

CONCLUSIONS

High prevalence of herbal CAM use was observed for both Hispanic and non-Hispanic white women. Results highlight the need for healthcare providers to query women regarding CAM use to identify potential interactions with traditional treatments and to determine whether CAM is used in lieu of traditional medications.

The Effect of Yoga on Menstrual Disorders: A Systematic Review

OBJECTIVE

To summarize and evaluate evidence for the effect of yoga on menstrual disorders.

METHODS

PubMed, CINAHL/MEDLINE, Web of Science, AMED, and Scopus were searched for English-language literature relevant to the review question. All primary research studies were included.

RESULTS

Fifteen studies described in 18 papers were included in the review. A range of yoga interventions were used. Some studies used a combination of Asana, Pranayama, and other yogic relaxation or meditation techniques. All included studies reported some change in their outcome measures, suggesting reduced symptoms of menstrual distress following a yoga intervention; however, the heterogeneity and intensity of the interventions and outcome measures meant that findings have limited generalizability and applicability in practice settings.

CONCLUSIONS

Further research on the relationship between yoga practice and menstrual disorders is warranted, but there must be both consistency in the methods, measures, and quality of studies and a shift toward research on yoga practices that are replicable outside of the clinical trial setting.

The Effect of Iyengar Yoga and Strengthening Exercises for People Living with Osteoarthritis of the Knee: A Case Series

This case series describes the impact of various forms of exercise on symptoms associated with osteoarthritis of the knee. A group of 15 women and men performed one of the following: traditional stretching and strengthening exercises, Iyengar yoga, or no structured group exercise. Low back and hamstring flexibility and quadriceps strength and function were monitored before and after the program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess subjective change after the six-week intervention period. A global assessment questionnaire was also completed by each participant and each instructor at the exit sessions to measure perceived changes in improvements since the initiation of the intervention. This study found functional changes and improvement in quality of life in traditional exercise and a yoga based approach that should encourage further comprehensive and carefully designed studies of yoga in osteoarthritis.

Herbal Product Use by African American Older Women

The purposes of this study were to identify patterns of herbal product use for health promotion and self-care management among older African American women, to explore their use of herbal products to manage disease-specific symptoms, and to compare users of herbal products to nonusers. The sample consisted of 57 community-residing African American women age 65 years and older. Of the sample, 33% used herbal product(s) within the past year. Those who used herbal products perceived their overall health to be better than those who did not use herbal products. However, differences in demographic characteristics and locus of control between herbal users and nonusers were not significant. More than 40% of the herbals used were not discussed with health care providers. Most participants using herbals were mixing herbal, prescription, and overthe-counter products. Indiscriminate use of herbal products in combination with or in place of conventional medicines can be problematic and costly.

Impact of Race and Gender on Utilization Rate of Total Shoulder Arthroplasty

Marked underutilization rates of total joint arthroplasty in minorities compared with nonminorities exist, with a paucity of literature surrounding inequities related to total shoulder arthroplasty (TSA). Using the Statewide Planning and Research Cooperative System database, patients who underwent elective TSA in New York State (NYS) were identified and characterized by age, race, gender, medical comorbidities, and payor status. Patients were stratified into 4 separate 5-year periods from 1990 to 2009. Comorbidity severity was defined using the Elixhauser criteria. A total of 10,538 elective TSAs were identified, with half of the procedures occurring in the most recent time quartile. Whites accounted for 70% of the procedures, whereas blacks accounted for 5%. During the 20-year period, the age-adjusted incidence of TSA in white men and women increased by 417% and 421%, respectively, whereas the incidence for black men and women increased by 378% and 329%, respectively. Black men had the lowest utilization rate among all subgroups, and overall disparity between races continued to widen over time. Blacks had significantly more comorbid conditions (P<.001) than whites when undergoing TSA. Blacks were more likely to have Medicaid insurance and less participation in Medicare (P<.001). Racial and gender disparities clearly exist in TSA utilization rates in NYS and may be worsening. Although reasons for these disparities are likely multifactorial, a deeper understanding of the factors involved in patient selection and access to care is necessary to appropriately address these disparities and effect change at a system-wide patient and provider level. [Orthopedics. 2016; 39(3):e538-e544.].

Effects of yoga on utero-fetal-placental circulation in high-risk pregnancy: a randomized controlled trial

Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues. Methods. 59 high-risk pregnant women were randomized into yoga (n = 27) and control (n = 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation. Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P = 0.001), head circumference (P = 0.002), femur length (P = 0.005), and estimated fetal weight (P = 0.019). The resistance index in the right uterine artery (P = 0.01), umbilical artery (P = 0.011), and fetal middle cerebral artery (P = 0.048) showed significantly lower impedance in the yoga group. Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation.

Feasibility and Acceptability of an Internet-Based, African Dance-Modified Yoga Program for African-American Women with or at Risk for Metabolic Syndrome

African-American (AA) women are the segment of the population that experiences the highest mortality from metabolic syndrome (MetS). Yoga decreases risk of MetS, yet there have been no yoga studies of AA women with or at risk for MetS. The purpose of this 4-week study was to test the feasibility and acceptability of a culturally tailored, Internet-based intervention, yogic dance (YD), using digital videos in a sample of AA women (ages 35-64) at risk for or with MetS. The investigators examined the rates of accrual, attrition, and reasons for attrition; the feasibility of using the Internet to deliver the intervention; the acceptability of the intervention as structured; and any other benefits and/or limitations of YD. The study used a single-group, mixed-methods design underpinned by social constructivist theory and Pender's Health Promotion Model. Twenty-four women provided consent to enroll in the study. After completing in-person semi-structured interviews and Internet-based measures, including the Physical Activity Readiness Questionnaire, and the modified International Physical Activity Questionnaire, consented participants engaged in 4-weeks of the yogic dance intervention via daily video-based instructions located on the study Web site. After the intervention, four women participated in focus groups to voice their perceptions of barriers to and benefits from YD and the acceptability of using the YD intervention. The investigators analyzed focus group data using content/thematic analysis and validated themes with baseline semi-structured interviews. The majority of the women (79%) found YD acceptable. Themes that emerged from the descriptive data include: (1) Culture is an important aspect of yogic dance; and (2) Increased social support would enhance yogic dance participation. The integrated results from this feasibility study will inform research exploring the complex correlates that influence health behaviors in AA women.

Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study

OBJECTIVES

To examine the associations between consultations with complementary and alternative medicine (CAM) practitioners and menopause-related symptoms.

METHODS

A cross-sectional survey of a nationally representative sample of 10 011 women aged 59-64 years from the Australian Longitudinal Study on Women's Health, conducted in 2010. Women, including those with hysterectomy, oophorectomy and natural menopause, were asked about their consultations with a range of CAM practitioners and menopause-related symptoms experienced.

RESULTS

Acupuncturists were more likely to be consulted by women with hysterectomy experiencing night sweats (odds ratio, OR = 2.21), but were less likely to be consulted by those experiencing hot flushes (OR = 0.53). Acupuncturists were also more likely to be consulted by women with oophorectomy (OR = 3.11) and natural menopausal women (OR = 1.57) experiencing back pain. Massage therapists were more likely to be consulted by women with oophorectomy experiencing back pain (OR = 1.98), women with hysterectomy experiencing anxiety (OR = 1.52), and natural menopausal women experiencing back pain (OR = 1.54) and/or anxiety (OR = 1.29). Naturopaths/herbalists were more likely to be consulted by women with oophorectomy experiencing leaking urine (OR = 2.08). Chiropractors/osteopaths were more likely to be consulted by women across all menopausal status experiencing back pain (OR = 2.52, 2.31 and 2.25 for women with oophorectomy, hysterectomy and natural menopause, respectively).

CONCLUSIONS

There are substantial levels of CAM practitioners' consultations amongst menopausal women, with a range of menopause-related symptoms associated with the use of specific CAM practitioner modalities. It is important that health-care providers are mindful of CAM practitioner use in order to ensure safe, effective and coordinated treatment and support for menopausal women in their care.

The beneficial effects of massage therapy for insomnia in postmenopausal women

With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research.

Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association

BACKGROUND AND PURPOSE

This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

METHODS

Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.

CONCLUSIONS

Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

Treatment of pregnancy-related lumbar and pelvic girdle pain by the yoga method: a randomized controlled study

OBJECTIVE

Pregnancy-related lumbopelvic pain is a major problem for the majority of pregnant women. Complementary medicine has been used to alleviate pain, and yoga is one of the most commonly chosen alternative methods. The objective of this study was to assess the effectiveness of Hatha yoga in the reduction of lumbopelvic pain in pregnancy.

METHODS

A randomized controlled trial with 60 pregnant women (age range, 14-40 years) who reported lumbopelvic pain at 12 to 32 weeks of gestation was conducted from June 2009 to June 2011. Pregnant women who had twin pregnancies, had medical restrictions for exercise, used analgesics, and participated in physical therapy were excluded from the study. Pregnant women were divided into two groups: the yoga group, practicing exercises guided by this method, and the postural orientation group, performing standardized posture orientation according to instructions provided in a pamphlet. Treatment in each group lasted 10 weeks. A visual analog scale (VAS) was used to measure pain intensity. Lumbar pain and posterior pelvic pain provocation tests were used to confirm the presence of pain. Statistical analysis included the Mann-Whitney test, the McNemar test, a paired Wilcoxon test, and analysis of covariance.

RESULTS

The median pain score was lower in the yoga group (p<.0058) than the postural orientation group. Lumbar pain provocation tests showed a decreased response in relation to posterior pelvic pain provocation tests and a gradual reduction in pain intensity during 10 yoga sessions (p<.024).

CONCLUSIONS

The yoga method was more effective at reducing lumbopelvic pain intensity compared with postural orientation.

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.

The use of Complementary and Alternative Medicine by women experiencing menopausal symptoms in Bologna

Background

The present study describes Complementary and Alternative Medicine (CAM) use amongst Italian women transitioning through menopause. Popularity and perceived effectiveness of CAM treatments, use of pharmaceutical medications, characteristics of CAM users, the extent of communication between medical practitioners and women about their use of CAM, and variables associated with CAM use were also investigated.

Methods

Women, aged 45-65 years attending Family Planning and Women's Health clinics or Menopause Centres in Bologna were invited to complete a voluntary, anonymous, self administered questionnaire, which was used in a previous study in Sydney. The questionnaire was translated and adapted for use amongst Italian women. Data on general demographic and health characteristics, menopause related symptoms and the use of CAM and pharmaceutical treatments during the previous 12 months were collected.

Results

In total, 1,203 women completed the survey, of which 1,106 were included in the final sample. Of women who had symptoms linked with menopause and/or used remedies to alleviate symptoms, 33.5% reported to have used CAM. Among these, 23.5% had consulted one or more practitioners and 24% had used at least one CAM product.

Approximately nine out of ten respondents reported medical practitioners did not seek information about their use of CAM; while one third of CAM users did not disclose the use of CAM to their physician. Nevertheless, medical practitioners were the most popular source of information. From the multivariate analysis, variables associated with CAM use were: professional employment, time since the last natural menses, use of CAM for conditions other than menopause, and presence of some severe symptoms.

Conclusions

The relatively high prevalence of CAM use by women transitioning through menopause should encourage research initiatives into determining which CAM treatments are the safest and effective. The increasing and likely concomitant use of CAM with HRT and other pharmaceuticals underlines the need for the implementation of a surveillance system to report and monitor possible drug-herb adverse events. The discrepancy between women preferring to seek information about CAM from their medical doctor and the difficulties noted in communication between doctor and patient should encourage educational initiatives on CAM by health-care agencies and institutions.

Health practices and vaginal microbicide acceptability among urban black women

BACKGROUND

Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Use of vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practices related to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs. Given the high rate of HIV infection among black women, research on practices and decision making relevant to microbicide acceptability is needed in this population.

METHODS

Twenty-three black women in New York City, aged 25-64, completed in-person semistructured interviews and self-administered questionnaires. Quantitative analyses examined vaginal practices and willingness to use microbicides. Qualitative analyses explored underlying decision-making processes involved in choices regarding vaginal practices and general healthcare.

RESULTS

Willingness to use vaginal products for HIV prevention was high, especially among more educated women. Safety was a major concern, and women were cautious about using vaginal products. Whereas some viewed synthetic products as having potentially harmful side effects, others perceived natural products as risky because of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy, prior experience, cultural background, and general approach to healthcare.

CONCLUSIONS

The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention. Decision-making processes regarding vaginal practices were complex and were affected by social, cultural, and personal factors. Although specific preferences may vary, attitudes toward using a vaginal product are likely to be positive when side effects are minimal and the product is considered safe.

Medical pluralism among American women: results of a national survey

BACKGROUND

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.

METHODS

A nationally representative telephone survey of 808 women >or=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.

RESULTS

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.

CONCLUSIONS

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.

The illness beliefs, perceptions, and practices of Filipino Americans with hypertension

PURPOSE

The purpose of this study was to describe the illness beliefs, perceptions, and practices of Filipino Americans (FAs) with hypertension (HTN) to reveal their explanatory models (EMs) of the illness.

DATA SOURCES

Audiotapes and transcripts of focus group interviews and observational notes were subjected to content analysis. Medical records and related empirical studies provided supporting data.

CONCLUSIONS

In general, the EMs of FAs with HTN correspond to the biomedical model in relation to causes, consequences, and treatment of HTN. However, in spite of this biomedical knowledge, FAs with HTN have difficulty maintaining the required lifestyle changes and adhering to the medication regimen to control their illness.

IMPLICATIONS FOR PRACTICE

It is important for NPs to assess the EMs of FAs with HTN, including their use of traditional folk remedies and practitioners of folk medicine. The challenge is to provide cardiovascular health promotion and education in a culturally sensitive, congruent, and tailored manner to FAs with HTN to help them control their illness.

Exercise and self-esteem in menopausal women: a randomized controlled trial involving walking and yoga

PURPOSE

To examine the effects of walking and yoga on multidimensional self-esteem and roles played by self-efficacy, body composition, and physical activity (PA) in changes in esteem.

DESIGN

Four-month randomized controlled exercise trial with three arms: walking, yoga, and control.

SUBJECTS

Previously low-active middle-aged women (n=164; M age = 49.9; SD = 3.6).

INTERVENTION

Structured and supervised walking program meeting three times per week for I hour and supervised yoga program meeting twice per week for 90 minutes.

MEASURES

Body composition, fitness assessment, and battery of psychologic measures.

ANALYSIS

Panel analysis within a structural equation modeling framework using Mplus 3.0.

RESULTS

The walking and yoga interventions failed to enhance global or physical self-esteem but improved subdomain esteem relative to physical condition and strength (for walking) and body attractiveness (for both walking and yoga). Over time the effects of PA, self-efficacy, and body fat on changes in physical self-esteem and global esteem were mediated by changes in physical condition and body attractiveness subdomain esteem. Women reporting greater levels of self-efficacy and PA with lower body fat also reported greater enhancements in subdomain esteem.

CONCLUSION

These results provide support for the hierarchic and multidimensional nature of self-esteem and indicate that middle-aged women may enhance certain aspects of physical self-esteem by participating in PA.

Elucidation of danzhixiaoyao wan and its constituent herbs on antioxidant activity and inhibition of nitric oxide production

Danzhixiaoyao Wan (DW) is a common 10 herbs formulation in China for regulating several clinical conditions affecting women. This research tried to explain one of DW's functions, purging heat, using in vitro pharmacological analyses. The whole formulation and each single herb of DW were compared based on antioxidant activity with the oxygen radical absorbance capacity (ORAC) assay, and for their inhibitory effect (IE) on nitric oxide (NO) production by lipopolysaccharide (LPS)-activated RAW 264.7 macrophages with the Griess assay. The results showed that DW as a whole formulation had both antioxidant activity and an IE on NO production, while the individual herb component of DW varied in their ORAC values and inhibition of NO production. The ORAC value of the whole DW was 450 mumol TE g(-1). The order of antioxidant (ORAC) activity of the single herbs was: Mentha haplocalyx (1352 mumol TE g(-1)) > Glycyrrhiza uralensis (1184 mumol TE g(-1)) > Gardenia jasminoides (1129 mumol TE g(-1)) > Paeonia suffruticosa (465 mumol TE g(-1)), with the contributions being additive rather than synergistic. The production of nitrite by stimulated RAW 264.7 murine macrophages (unstimulated: 0.5 +/- 0.1 muM versus LPS: 38.9 +/- 2.3 muM) was significantly inhibited (P < 0.05) by M. haplocalyx, G. jasminoides, Bupleurum chinense and Paeonia lactiflora. DW as a whole had an IE on NO production, but this was not significant. The single herb M. haplocalyx had the highest ORAC value and the highest IE on NO production, followed by G. jasminoides. Both of these herbs have the 'purging heat' property in the theory of traditional Chinese medicine and this property of the samples may be correlated with the antioxidant activity and IE on NO production.

Cross-sectional analysis of specific complementary and alternative medicine (CAM) use by racial/ethnic group and menopausal status: the Study of Women's Health Across the Nation (SWAN)

OBJECTIVE

To examine the relationships of race/ethnicity, menopausal status, health characteristics, and symptoms with use of 21 types of complementary and alternative medicine (CAM) in midlife women.

DESIGN

Cross-sectional, multiple logistic regression analyses of 2,118 women completing the sixth annual visit in the Study of Women's Health Across the Nation, a multisite, multiethnic, longitudinal study.

RESULTS

More than half of women used some type of CAM. Use of most types of CAM differed significantly by race/ethnicity, except the use of ginkgo biloba and glucosamine. Significantly more African Americans at most sites and Chinese women used ginseng. Use of most types of CAM did not differ significantly by menopausal status or vasomotor symptoms, except the use of soy supplements, which was significantly greater among women who reported vasomotor symptoms. Women reporting somatic symptoms were significantly more likely to use glucosamine. Women reporting psychological symptoms were significantly more likely to use ginkgo biloba and soy supplements. The number of comorbidities, moderate or high socioeconomic status, number of healthy behaviors, symptom sensitivity, age, and dietary genistein intake were significantly positively associated with use of several types of CAM.

CONCLUSIONS

The use of most types of CAM is not related to menopausal status or symptom reporting but to sociodemographic factors, comorbidities, and health behaviors. Given the large proportion of midlife women who use CAM and the potential for interactions with prescribed medications, healthcare practitioners should inquire about CAM use and be aware of which factors influence the use of different types of CAM.

Silent voices: Women, complementary medicine, and the co-optation of change

Despite the prominence of complementary and alternative medicine (CAM) in public and policy debates, our knowledge of the relationship between CAM and gender remains undeveloped. By tracing two dominant strands of research involving the women's health movement and the implications of CAM's increasing popularity among women, this article draws attention to the need for research addressing the roles of women as practitioners and students of CAM. It is argued that the medicalization and co-optation of CAM has serious implications for women's health by constraining CAM's potential to challenge, resist, and transform the hegemony and inequalities of biomedicine.

Complementary and alternative medicine use among American women: findings from The National Health Interview Survey, 2002

BACKGROUND

The prevalence of use of complementary and alternative medicine (CAM) among Americans is high, especially among women, but a national profile of women CAM users has yet to be characterized. This study identified sociodemographic, health, and lifestyle factors associated with use of various types of CAM among women in the United States and examined health conditions and reasons for use.

METHODS

Data from the 2002 National Health Interview Survey (NHIS), a nationally representative sample of U.S. adults, were analyzed (n = 17,295 women). Any recent use of CAM as well as specific types of CAM (e.g., biologically based therapies) use were analyzed; prayer was considered separately. Prevalence estimates and logistic regression results were weighted, and variance estimates were adjusted for complex sample design.

RESULTS

About 40% of women reported any recent CAM use. Biologically based therapies (23.8%) were the most frequently reported CAM type, followed by mind-body therapies (20.9%). User characteristics were generally similar across specific CAM types; there were some differences between women who used CAM and women who prayed for health. Women frequently reported using CAM in conjunction with conventional medicine and to treat chronic pain conditions.

CONCLUSIONS

This study provides a comprehensive profile of recent CAM use among a national sample of American women, including user characteristics and reasons and conditions for use. Widespread CAM use reflects a social phenomenon of healthcare-seeking practices that can potentially inform public health strategies for health promotion and disease prevention.

Complementary and alternative medicine use among Hispanics in the United States

OBJECTIVE

To review the use of complementary and alternative medicine (CAM) in Hispanics in the US and highlight the modalities most likely to be unfamiliar to healthcare practitioners.

DATA SOURCES

A search of the literature published in English and a subsequent bibliographic search were conducted using MEDLINE, International Pharmaceutical Abstracts, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and Manual Alternative and Natural Therapy Index System (1980-March 2007). Primary search terms included, but were not limited to, Hispanic, Latino, complementary and alternative medicine, and dietary supplements. Studies that assessed or evaluated the use of CAM in the Hispanic population were reviewed. Articles that included both Hispanics and non-Hispanics were also included.

STUDY SELECTION AND DATA EXTRACTION

The literature search yielded 42 articles focused on the use of CAM by Hispanics. Survey was the most common method used in these studies, although some hybrid interviews were also conducted.

DATA SYNTHESIS

Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. Some trials examined overall CAM use, whereas others looked at specific dietary supplements and herbs. Most reports found a higher than expected rate of CAM use in Hispanics (50-90%). A number of products potentially unfamiliar to healthcare practitioners, such as linden, sapodilla, and star anise, were reported as commonly used in several studies. Many studies were limited by the sample size or use of only one Hispanic subgroup.

CONCLUSIONS

Hispanics use a wide range of CAM therapies, including several that may be unfamiliar to healthcare practitioners. Understanding the rationale, motivations, and history of Hispanics' use of CAM will enhance the cultural competence of healthcare professionals and help address these patients' medical needs.

Women's reasons for complementary and alternative medicine use: racial/ethnic differences

OBJECTIVES

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.

DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

Chiropractic and CAM utilization: a descriptive review

OBJECTIVE

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

DATA SOURCES

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

DATA SELECTION

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

DATA SYNTHESIS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Use of herbs and herbal products by Hispanics in south Florida

OBJECTIVES

To provide insight into the use of herbs by Hispanic Americans, identify specific herbal products that health care professionals should inquire about in this population, and assess information sources and expenditures.

DESIGN

Cross-sectional survey.

SETTING

South Florida.

PARTICIPANTS

Convenience sample of 200 Hispanic adults.

INTERVENTIONS

Participants completed a descriptive, self-administered survey.

MAIN OUTCOME MEASURES

Specific herbs and herbal remedies use, monthly expenditures, sources of information, and attitudes and beliefs regarding herbs.

RESULTS

Of the 200 surveys that were distributed, 142 were completed for a response rate of 71%. Of the respondents, 75% reported using at least one herb in the last 12 months. Women between 25 and 34 years of age were most likely to be herb users (P = .001), while men in that age group were the least likely (P = .013). Chamomile (58.5%) and aloe vera (45.3%) were used most frequently. Two frequently used herbs--linden (35.8%) and star anise (33.0%)--are ones that are generally not well known to health care professionals. Family tradition (36%) and safety (17%) were the major reasons for use of herb/herbal remedies. Participants most commonly reported spending 25 dollars or less per month for herbs and herbal products.

CONCLUSION

Hispanics in south Florida reported using herbs and herbal products at a higher rate than that those reported previously for the general population of the United States. While money spent on herbs and herbal products was generally minimal, study participants had a disconcerting level of confidence in the safety and efficacy of herbal products.

Pediatric Patients with Sickle Cell Disease: Use of Complementary and Alternative Therapies

OBJECTIVE

Despite clinical advances, sickle cell disease (SCD) remains a difficult, chronic medical condition for many children and youth. Additional treatment strategies, including complementary and alternative medicine (CAM) therapies, would be welcome to enhance the clinical care of SCD patients. This study's objective was to identify CAM therapies that are currently used by families for children with SCD, and to investigate SCD families' interest in CAM.

PATIENTS AND METHODS

Fifty-seven (57) parents of pediatric SCD patients participated in this cross-sectional telephone survey in early 2000. A SCD Severity Scale was developed by combining the general health assessment and four measures of SCD severity (Cronbach's alpha = 0.81).

RESULTS

Fifty-four percent (54%) of the sample used CAM therapies for the SCD children. Forty-two percent (42%) used bioenergetic therapies (prayer, spiritual and energy healing), 28% used lifestyle/mind?body CAM (relaxation techniques, exercise, imagery, and diet), 12% used biochemical therapies (herbal medicines, megavitamins, and folk remedies), and 5% used biomechanical therapy (massage). CAM use for the SCD children was positively associated with the child's age, SCD Severity Scale score, respondent education, and respondent CAM use. The use of relaxation techniques was associated with greater SCD severity. Most respondents (83%) felt that CAM can be helpful.

CONCLUSIONS

The use of CAM therapies is common for children with SCD. Prayer, relaxation techniques, and spiritual healing were the most commonly reported CAM therapies. Because clinical studies have shown the benefit of spiritual and relaxation practices for SCD and this study shows that these CAM therapies are being used commonly by SCD families, future research should focus on spiritual and relaxation practices for children with SCD.

Use of Coptidis Rhizoma and foetal growth: a follow-up study of 9895 pregnancies

PURPOSE

To explore the effect of Coptidis Rhizoma on foetal growth in pregnancy.

METHODS

During 1985-1987, each pregnant woman with 26 or more weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital for prenatal care was enrolled and interviewed by three trained interviewers using structured questionnaires to obtain detailed information including the herbal medicines used during pregnancy. Medical histories of diabetes, hypertension, antepartum haemorrhage and medicines used during pregnancy were abstracted from medical records of mothers'. Data of birth weight, gestational duration and characteristics of infants were gathered from the Taiwan national birth registration. A total of 9,895 singleton livebirths were analysed. The variables related to foetal growth included two dichotomous measures: low birth weight (LBW) and small for gestational age (SGA); and one continuous measure: birth weight. Potential risk factors associated with these outcomes were investigated using multiple logistic and linear regression models.

RESULTS

After adjustment, pregnant women taking Coptidis Rhizoma during pregnancy had no significantly adverse effect on foetal growth. There was a non-significantly slightly decreased mean of birth weight and increased risk of LBW and SGA babies if the frequency of using Coptidis Rhizoma was more than 56 times.

CONCLUSIONS

The usual usage of Coptidis Rhizoma during pregnancy seemed not to increase the adverse risk on foetal growth. Future observations for use of longer than 56 times or a higher cumulated dose were needed to clarify the safety.

A national probability survey of American Medical Association gynecologists and primary care physicians concerning menopause

OBJECTIVE

This survey intended to clarify physicians' understanding of the issues surrounding women, menopause, alternative medicine, and drug therapy for the treatment of menopause.

STUDY DESIGN

This study was designed as a national probability sample survey of primary care physicians and gynecologists nationwide. Its focus was to identify major concerns and issues identified by patients about menopause and perceived communication with effectiveness how to communicate with their patients. Physicians were also asked to rate their comfort level in recommending the use of herbal remedies and which herbal remedy they felt comfortable recommending to interested patients.

RESULTS

Data indicated that a patient's complaint about menopausal symptoms was the most common factor leading to discussion of menopausal issues with physicians (91%) and that the primary concern to the patient was management of menopausal symptoms. Other factors were controversies about hormone replacement therapy, long-term health implications of menopause, and hormone replacement therapy. Eighty percent of the physician found confusing messages with regard to menopause to be the most challenging aspect in patient communication. The second most challenging issue is "inconclusive data about hormone replacement therapy" (56%). Seventy-six percent of the physicians found "showing sympathy" to be the most important factor for the physicians to communicate effectively with patients, whereas "being honest and open" was the most important patient attitude cited for the same purpose. When it comes to herbal therapy for menopause symptom control, only 4% of the physicians indicated that none of their patients take any remedies. Only 18% were not very comfortable in discussing or recommending herbal therapies, whereas the rest ranged from fairly comfortable to completely comfortable.

CONCLUSION

This study has provided data with regard to physician understanding of menopause treatment options and their primary interaction with patients on this issue. More in-depth studies concerning efficacy and/or side effects of each available treatment will be the relevant next step, given the controversies about both hormone replacement therapy and alternative therapies. The relative efficacy, safety, and cost-effectiveness of different treatments should also be put into the context of both clinical diagnosis and physicians' clinical judgment. Attention to comments by physicians and patients with regard to communication may produce better information exchange and trust between patient and physician.

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.