Slides from presentation at:  The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APH

Orwig, Denise

Ryder, Priscilla T.

Wolpert, Beverly

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Butler UniversityDigital Commons @ Butler UniversityScholarship and Professional Work – COPHS College of Pharmacy & Health Sciences2007Alternative and complementary health practices(ACHP) among older urban African AmericansBeverly WolpertPriscilla T. RyderButler University, pryder@butler.eduDenise OrwigFollow this and additional works at: http://digitalcommons.butler.edu/cophs_papersPart of the Alternative and Complementary Medicine Commons, and the Public HealthCommonsThis Article is brought to you for free and open access by the College of Pharmacy & Health Sciences at Digital Commons @ Butler University. It hasbeen accepted for inclusion in Scholarship and Professional Work – COPHS by an authorized administrator of Digital Commons @ Butler University.For more information, please contact fgaede@butler.edu.Recommended CitationWolpert, Beverly; Ryder, Priscilla T.; and Orwig, Denise, "Alternative and complementary health practices (ACHP) among olderurban African Americans" (2007). Scholarship and Professional Work – COPHS. Paper 93.http://digitalcommons.butler.edu/cophs_papers/93APHA 135th Annual MeetingWashington DC: November 3-7, 2007Beverly Wolpert, MS,1 Priscilla T. Ryder, MPH, PhD,2 and Denise Orwig, PhD11Department of Epidemiology & Preventive Medicine, University of Maryland School of Medicine; 2Pharmaceutical Health Services Research, University of Maryland School of PharmacyThe West Baltimore Study:Alternative and complementary health practices among older urban African AmericansCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Increasing attention from medical professionals & consumersz Increasing use among older Americans estimated by population surveysz 30% reported using ACHP in 2000z 88% reported using ACHP in 2005Rising popularity of alternative & complementary health practices (ACHP)Eisenberg 1993, Paramore 1997, Tindle 2005, Barnes 2004, Graham 2005, Foster 2000, Ness 2005.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Preventing diseasez Reducing expensesz Replacing ineffective conventional therapiesz Augmenting conventional carez Treating chronic conditionsWhy the rise in popularity of ACHP?Adams 1986, Astin 1998, Crone 1998, Becker 1998.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Different ethnic groups z Own systems of traditional medicinez Passage from generation to generationz Different socioeconomic & demographic groupsDiversity across ACHPBoyd 2000, Hufford 1995, Ripley 1986.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz More common among:z Womenz Middle-aged adultsz Better educatedz Higher income earnersGeneral profile of ACHP users in the USTindle 2005, Barnes 2004.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz ACHP use to prevent & treat illness among US minorities associated with:z Lower educationz Greater reported unfair race-based treatmentz Financial strainz Poorer health statusMinority ACHP usersBazargan 2005.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz ACHP use among adult non-Hispanic Whitesz Little insight into ACHP use among understudied & medically vulnerable groupsWhat the current knowledge reflectsEisenberg 1993, Paramore 1997, Tindle 2005, Barnes 2004, Graham 2005, Foster 2000, Ness 2005.Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Population-based telephone survey of older, community-dwelling African Americans contacted byz Random digit dialingz Community outreachz Associations of ACHP use with:z Chronic health conditionsz Disabilitiesz Mental well-beingz Neighborhood characteristicsz Reaction to race-based unfair treatmentThe West Baltimore StudyCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduWest Baltimore City residentEnglish-speakingAccess to landline telephoneCognitive impairmentSelf-identified African American/BlackInstitutional residence≥60 years oldExclusion criteriaInclusion criteriaCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduStudy areaCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduStudy sample3663 telephone numbers by random digit dialing2689 not eligible 851 consent not determined46 eligible refused 4 consented but not completed72 interviews completed40 contacts from community outreach23 interviews completed5 not eligible1 later declined11 unable to schedule by end of data collectionTotal: 95 interviews completedCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Questions similar to 2002 National Health Interview Survey CAM Supplementz Reasons for using 8 modalitiesz Acupuncturez Chiropracticz Group spiritual practicesz Herbs/home remedies/rootworkz Individual prayerz Massagez Meditation/visualization techniquesz Relaxation/biofeedbackMeasures:  self-report of past year’s ACHP use, excluding individual prayerCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Herbal medication usez Sociodemographicsz Economic statusz Social supportz Physical healthz Mental health z Discrimination & reaction to race z Neighborhood characteristicsFactors of interestCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Comparisons of ACHP users & nonusersz Chi-square testsz T-testsz Factors associated with ACHP usez Multivariable logistic regression models AnalysisCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduTable 1.  Demographics46 (63.0)0.0804 (57.1)42 (63.4)Annual household       income < $15k59 (62.8)27 (58.7)32 (66.7)Can count on family/friends all of the time59 (62.8)27 (58.7)32 (66.7)Lives alone59 (67.8)32 (66.7)27 (58.7)Attends religious services   at least once a week20 (21.5)10 (21.3)10 (20.8)Currently married11.8 ± 2.911.4 ± 2.812.2 ± 2.9Education (mean y ± SD)70.7 ± 7.80.04269.1 ± 7.872.4 ± 7.6Age (mean ± SD)21 (22.1)5 (23.8)16 (76.2)Male sexTotal (N=95)p-valueACHP nonusers (N=47)ACHP users (N=48)VariableCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduTable 2.  Bivariate analysis: health status44.4 ± 10.552.7 ± 9.546.5 ± 10.428.5 ± 13.650.7 ± 13.60.0410.03546.6 ± 10.951.3 ± 9.548.8 ± 12.5326.9 ± 16.950.8 ± 11.142.2 ± 9.954.2 ± 9.644.3 ± 13.330.1 ± 17.150.7 ± 10.9SF-12 measures4PCS-12 (mean ± SD)MCS-12 (mean ± SD)Physical functionBodily painVitality2 (2.1)17 (17.9)33 (34.7)43 (45.3)2 (4.3)9 (19.2)19 (40.4)17 (36.2)08 (16.7)14 (29.2)26 (54.2)Body mass indexUnderweightDesirable weightOverweightObese15 (15.8)8 (17.0)7 (14.6)Depressive symptoms36.2 ± 3.10.0095.4 ± 2.97.0 ± 3.1Reported diagnoses2 (mean ± SD)61 (64.2)28 (59.6)33 (68.8)          Self-rated health excellent, very good, or goodTotal (N=95)p-valueACHP nonusers (N=47)ACHP users1(N=48)VariableCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduTable 3.  Health insurance & healthcare utilization11.1 ± 16.411.0 ± 18.111.2 ±14.8Prior year healthcare visits5(mean no. ± SD)19 (20.0)9 (19.2)10 (20.8)Prior year completion of preventive exams & procedures61 (1.1)64 (68.8)18 (19.4)15 (16.1)4 (4.3)1 (2.2)28 (60.9)7 (15.2)11 (23.9)--36 (76.6)11 (23.2)4 (8.5)4 (8.5)Usual source of healthcareNonePhysicianHospitalClinicEmergency department72 (77.4)21 (22.8)55 (60.4)3 (3.2)0.00831 (66.0)10 (22.2)30 (66.7)3 (6.4)41 (89.1) 11 (23.4)25 (54.4)-Health insuranceMedicareMedicaidPrivate/supplementalUninsuredTotal (N=95)p-valueACHP nonusers (N=47)ACHP users (N=48)VariableCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduTable 4.  Satisfaction with healthcare & neighborhood characteristics58 (61.7)33 (3.2)3 (3.2)29 (630)15 (32.6)2 (4.4)29 (60.4)18 (37.5)1 (2.1)SatisfactionVery satisfiedSomewhat satisfiedSomewhat dissatisfied17.9 ± 18.567.6 ± 8.626.3 ± 8.10.09315.1 ± 15.568.8 ± 6.125.3 ± 7.620.8 ± 20.966.4 ± 6.927.3 ± 8.6NeighborhoodRacial Diversity Index(RDI)7 (mean no. ± SD)Economic Diversity Index (EDI)8 (mean no. ± SD)Proportion of residentsbelow povertyTotal (N=95)p-valueACHP nonusers (N=47)ACHP users (N=48)VariableCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduTable 5.  Herb/home remedy use in past YearFat burner pillsSwollen thighsApple cider vinegar, witches’ broom, glucosamineArthritis/jointsHERB/HOME REMEDY USEDSPECIFIC CONDITIONLemon juice, onionsColdsHerbal teaConstipationHorehound & honeyCoughDiabeticine, cinnamonDiabetesLemon juiceFoot painBlack cohoshHot flashesGarlic, herbal teaHypertension EchinaceaImmune functionHerbal teaInsomniaHydrogen peroxideSoreness on skinSeleniumTo counter effects of smokingLuteinSightMustardNauseaOatmealCholesterol Copyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduHerb/home remedy use in past year: “cleansing”Watercress, turnip greens, green tea, black tea, “Q-gel Plus, “Kidney Clear pills”General systemicHERB/HOME REMEDY USEDTYPE OF CLEANSINGSassafrasBlood“Colon cleanser pills”Digestive systemHerb/home remedy use in past year:  prevention, wellness, & overall healthEchinacea, lemon grass, green tea, wheatgrass juice, goldensealCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduACHP knowledge & use in past year4 (4.2)86 (90.5)Chiropractic6 (6.3)82 (86.5)Massage 10 (10.6)67 (71.3)Meditation/visualization techniques28 (29.5)90 (94.7)Herbs/home remedies16 (17.0)85 (90.4)Group spiritual practices80 (84.2)92 (96.8)Individual prayer3 (3.2)87 (91.6)Acupuncture1 (1.1)54 (56.8)Relaxation/biofeedbackUsedN (%)Heard of N (%)ModalityCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduMultivariable logistic regression of ACHP use  (N=95 individuals, 19 neighborhoods)0.0071.24 (1.06, 1.45)Number of reported diagnoses0.0231.07 (1.00, 1.14)Age (y)0.0241.21 (1.03, 1.43)Years of educationp-valueAdjusted odds ratio (95% CI)Factor0.0630.93 (0.86, 1.00)Income inequality0.0471.03 (1.00, 1.06) 4Residential racial segregation0.0701.17 (0.99, 1.39)Number of reported diagnoses0.0231.09 (1.01, 1.17)Age (y)0.0241.24 (1.03, 1.49)Years of educationp-valueAdjusted odds ratio (95% CI)FactorÆ MODEL 2:  Individual & neighborhood characteristicsÆ MODEL 1:  Individual level onlyCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduDiscussionz Correlates of ACHP use include:z Agez Socioeconomic positionz Physical health/comorbidityCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduLimitationsz Small sample sizez Low response to RDD recruitmentz Limited generalizabilityCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduStrengthsz Population-based recruitment of the majority of participantsz Consideration of effects of unfair race-based treatmentz Consideration of neighborhood health influencesCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduConclusionsz Greater & more varied use of ACHP than previously suggestedz Higher awareness of ACHP use, especially multi-modal use, important among healthcare providers z Vulnerabilityz Interactionsz Larger explorations of ACHP use among older urban African Americans importantCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduReferences1. Adams WR. Economic factors influencing the use of folk remedies. Tex Med. 1986 Dec;82(12):32-3.2. Astin JA. Why patients use alternative medicine: results of a national study. Jama. 1998 May 20;279(19):1548-53.3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004(343):1-19.4. Bazargan M, Norris K, Bazargan-Hejazi S, et al. Alternative healthcare use in the under-served population. Ethn Dis 2005;15(4):531-9.5. Becker G, Beyene Y, Newsom EM, Rodgers DV. Knowledge and care of chronic illness in three ethnic minority groups. Fam Med. 1998;30(3):173-8.6. Boyd EL, Taylor SD, Shimp LA, Semler CR. An assessment of home remedy use by African Americans. J Natl Med Assoc 2000;92(7):341-53.7. Crone CC, Wise TN. Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy. Psychosomatics. 1998 Jan-Feb;39(1):3-13.8. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993 Jan 28;328(4):246-52.9. Foster DF, Phillips RS, Hamel MB, Eisenberg DM. Alternative medicine use in older Americans. J Am GeriatrSoc. 2000 Dec;48(12):1560-5.10. Graham RE, Ahn AC, Davis RB, O'Connor BB, Eisenberg DM, Phillips RS. Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey. J Natl Med Assoc. 2005 Apr;97(4):535-45.11. Hufford DJ. Cultural and social perspectives on alternative medicine: background and assumptions. AlternTher Health Med. 1995 Mar;1(1):53-61.12. Ness J, Cirillo DJ, Weir DR, Nisly NL, Wallace RB. Use of complementary medicine in older Americans: results from the Health and Retirement Study. Gerontologist. 2005 Aug;45(4):516-24.13. Paramore LC. Use of alternative therapies: estimates from the 1994 Robert Wood Johnson Foundation National Access to Care Survey. J Pain Symptom Manage. 1997 Feb;13(2):83-9.14. Ripley GD. Mexican-American folk remedies: their place in health care. Tex Med. 1986 Nov;82(11):41-4.15. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med 2005;11(1):42-9. 16. Images: garlic, www.savoringkentucky.com; black cohosh: www.arhomeandgarden.org; Oprah: www.associatedcontent.com; goldenseal: meded.ucsd.eduCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.eduz Funded by a grant from the University of Maryland Medical School’s Center for Integrative Medicine z Thanks to z Dr. Sania Amrz Dr. Sandra A. Blackz Dr. Olivia Carter-PokrasAcknowledgmentsCopyright 2007, Beverly J. Wolpert, bwolpert@epi.umaryland.edu

Alternative and complementary health practices (ACHP) among older urban African Americans

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Alternative and complementary health practices (ACHP) among older urban African Americans

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