Dejun Su

Trends in the Use of Complementary and Alternative Medicine in the United States: 2002–2007

In this study we seek to assess recent trends in complementary and alternative medicine (CAM) use based on a comparative analysis of data from the 2002 and 2007 National Health Interview Survey (NHIS). The findings suggest that CAM use, in particular the use of provider-based CAM therapies such as chiropractic care, massage, and acupuncture, have grown significantly in the U.S. This growth was more pronounced among non-Hispanic Whites than among racial and ethnic minorities, increasing an already existing White-minority gap in CAM use. Findings from this study also reveal that CAM use becomes more likely when access to conventional care has been restricted. In both 2002 and 2007, having unmet needs in medical care or having delayed care due to cost were associated with a higher chance of CAM use.

Racial and Ethnic Disparities in Awareness of Genetic Testing for Cancer Risk

BACKGROUND Racial and ethnic disparities in awareness of genetic testing for cancer risk are substantial. PURPOSE This study assesses the relative importance of contributing factors to gaps in awareness of genetic testing for cancer risk across racial and ethnic groups. METHODS Data from the 2005 National Health Interview Survey (N=25,364) were analyzed in 2009 to evaluate the contribution of demographic factors, SES, health status, nativity/length of residency in the U.S., personal/family history of cancer, and perceived cancer risk to racial and ethnic disparities in genetic testing awareness for cancer risk. The contribution of each factor was assessed using the Fairlie decomposition technique. RESULTS About 48% of non-Hispanic whites reported that they had heard about genetic testing, followed by 31% of blacks, 28% of Asians, and 19% of Hispanics. Education and nativity/length of residency in the U.S. explained 26% and 30% of the gap between whites and Hispanics, respectively. Education accounted for 22% of the white-black gap, with residential region explaining another 11%. Nativity/length of residency in the U.S. explained 51% of the white-Asian gap. CONCLUSIONS The relative importance of factors contributing to racial and ethnic disparities in genetic testing awareness is specific to the particular groups under comparison. Diverse, culturally competent approaches are needed to improve awareness for different racial and ethnic groups.

Cross-border utilization of health care: evidence from a population-based study in south Texas.

OBJECTIVE To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. DATA AND METHODS This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. PRINCIPAL FINDINGS Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. CONCLUSIONS The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.-Mexico border region.

Physical Activity and Mortality Among Middle-Aged and Older Adults in the United States

BACKGROUND Physical activity (PA) has been routinely linked to lower all-cause mortality, yet extant research in the United States is primarily based on nonrepresentative samples. Evidence is scant on the relative and independent merits of leisure-time (LTPA) versus non-leisure-time (NLTPA) activities and how the PA-mortality link may vary across racial-ethnic-gender groups. METHODS Data were from Health and Retirement Study which began in 1992 collecting data on individuals aged 51-61 years who were subsequently surveyed once every 2 years. The current study assessed group-specific effects of LTPA and NLTPA measured in 1992 on mortality that occurred during the 1992-2008 follow-up period. Cox proportional hazard analyses were performed to examine the PA-mortality link. RESULTS Net of a wide range of controls, both LTPA and NLTPA showed a gradient negative relation with mortality. No gender-PA interaction effects were evident. Some interaction effects of PA with race-ethnicity were found but they were weak and inconsistent. The mortality reduction effects of PA seemed robust across racial-ethnic-gender groups. CONCLUSIONS Regardless of personal background, PA is a major health promoting factor and should be encouraged in aging populations. More research is needed to assess relative merits of different types and domains of PA.

Occupational career and risk of mortality among US Civil War Veterans

Previous studies have extended the traditional framework on occupational disparities in health by examining mortality differentials from a career perspective. Few studies, however, have examined the relation between career and mortality in a historical U.S. population. This study explores the relation between occupational career and risk of mortality in old age among 7096 Union Army veterans who fought the American Civil War in the 1860s. Occupational mobility was commonplace among the veterans in the postbellum period, with 54% of them changing occupations from the time of enlistment to 1900. Among veterans who were farmers at enlistment, 46% of them changed to a non-farming occupation by the time of 1900. Results from the Cox Proportional Hazard analysis suggest that relative to the average mortality risk of the sample, being a farmer at enlistment or circa 1900 are both associated with a lower risk of mortality in old age, although the effect is more salient for veterans who were farmers at enlistment. Occupational immobility for manual labors poses a serious threat to chance of survival in old age. These findings still hold after adjusting for the effects of selected variables characterizing risk exposures during early life, wartime, and old age. The robustness of the survival advantage associated with being a farmer at enlistment highlights the importance of socioeconomic conditions early in life in chance of survival at older ages.