Jae Kennedy

Patient disclosure about herb and supplement use among adults in the US

Analyses of 2002 National Health Interview supplement on complementary and alternative medicine (NHI%AM) indicate that approximately 38 million adults in the US (18.9% of the population) used natural herbs or supplements in the preceding 12 months, but only one-third told their physician about this use. The objectives of this study are: (i) to determine subpopulation rates of patient–physician communication about herbal product and natural supplement use and (ii) to identify the relative influence of patient factors and interaction factors associated with patient-physician communication about herb and supplement use. Logistic secondary analysis was done by using the complementary and alternative medicine supplement of the 2002 National Health Interview Survey. Subjects were a random stratified sample of US adults who used herbs in the past 12 months (n = 5 196) and self-reported rates of disclosure to physicians about herb and supplement use. Results show that disclosure rates were significantly lower for males, younger adults, racial and ethnic minorities and less intensive users of medical care. Across subpopulations, disclosure was the exception rather than the norm. Given the potential risks of delayed or inappropriate treatment and adverse drug reactions and interactions, physicians should be aware of herb and supplement use and counsel patients on the potential risks and benefits of these treatments.

Drug Affordability and Prescription Noncompliance in the United States: 1997-2002

BACKGROUND Prescription drug costs have risen rapidly since the mid-1990s. Inability to pay for medications has consequences for population health and health system costs. However, national data on the scope of prescription noncompliance due to cost are surprisingly inconsistent. OBJECTIVE The goals of this study were to use data from a large, all-ages survey that accurately represents the civilian, noninstitutionalized population to estimate the national prevalence of medication noncompliance due to cost, identify sources of variation in rates of noncompliance due to cost, and assess changes in these rates over a recent 6-year interval (1997-2002). METHODS We undertook a trend analysis of the National Health Interview Surveys for 1997 through 2002 and detailed subpopulation analysis of the 2002 survey to determine rates of noncompliance due to cost. RESULTS Our analyses used a total sample size of 276,425 respondents for the 6-year period and a sample size of 43,568 respondents for the year-2002 subpopulation analysis. Self-reported rates of noncompliance due to cost grew from 4.7% in 1997 to 5.9% in 2002. The results of the 2002 survey suggested that noncompliance varied by subpopulation, with relatively high rates (P < 0.001) among working-age adults (ie, aged 18-64 years), women, blacks, Medicaid and Medicare beneficiaries, those with low incomes, and those without health insurance. CONCLUSION A relatively small but growing proportion of Americans are unable to afford the medications they are prescribed. Cost-associated noncompliance, like other health care access problems, is unevenly distributed in the population.

A cross-national study of prescription nonadherence due to cost : Data from the joint Canada-United States survey of health

BACKGROUND In Canada and the United States, patients who have difficulty paying for prescribed medications are less likely to obtain them and may experience increased risks for morbidity and mortality and/or increased health care costs due to nonadherence. As prescription drug costs have risen, the ability to pay for medications has emerged as a critical public health issue. OBJECTIVES The objectives of this study were to estimate the rates of cost-associated nonadherence in Canada and the United States, and to identify factors that predict cost-associated nonadherence in both countries. METHODS This original analysis used data from the 2002/2003 Joint Canada-US Survey of Health, a household phone survey jointly conducted by Statistics Canada (Ottawa, Ontario, Canada) and the US National Center for Health Statistics (Hyattsville, Maryland). The sample included 3505 adults in Canada and 5183 adults in the United States. Weighted group comparisons and logistic regression analyses were used to identify population factors predictive of cost-associated prescription nonadherence. RESULTS Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs 9.9%; P < 0.001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P < 0.001). In addition to country of residence and insurance coverage, significant risk factors predictive of nonadherence were young age, poor health, chronic pain, and low household income. CONCLUSIONS The results of this analysis suggest that people with low incomes and inadequate insurance, as well as those with poor health and/or chronic symptoms, are more likely to report failing to fill a prescription due to cost. The overall rate of cost-associated nonadherence was significantly higher in the United States than in Canada, even when other person-level factors were controlled for, including health insurance and prescription-drug coverage.

Cost-related prescription nonadherence in the united states and Canada: A system-level comparison using the 2007 international health policy survey in seven countries

BACKGROUND Prior research indicates that residents of the United States are nearly twice as likely as Canadian residents to report cost-related nonadherence (CRNA) (ie, being unable to fill > or =1 prescription due to cost). However, these kinds of national comparisons obscure important within-country differences in insurance coverage. OBJECTIVE This study was designed to compare rates of CRNA across major financing systems for prescription drugs in the United States and Canada. METHODS This study used the 2007 International Health Policy Survey in Seven Countries (supported by the US Commonwealth Fund) to estimate rates of CRNA in the following health systems: Canadian compulsory coverage (Quebec), Canadian senior and social assistance coverage (Ontario), Canadian income-based coverage (British Columbia, Manitoba, and Saskatchewan), Canadian mixed coverage (all other provinces), US private coverage (employer-based or individual insurance), US senior and social assistance coverage (Medicare and/or Medicaid), and US no coverage (uninsured). RESULTS Adults in the United States were far more likely than adults in Canada to report CRNA (23.1% vs 8.0%; chi(2) = 147.4; P < 0.001). Seniors (> or =65 years of age) were less likely than younger adults (<65 years) to report CRNA in both the United States (9.2% vs 25.8%; chi(2) = 64.3; P < 0.001) and Canada (4.6% vs 8.7%; chi(2) = 14.9; P < 0.001), presumably due to categorical eligibility for prescription drug insurance. Comparative analyses therefore focused on working-age adults (<65 years). Adults in Quebec (who have compulsory drug coverage) were only half as likely as those in Ontario to report CRNA (odds ratio [OR] = 0.5; 95% CI, 0.3-0.8). Uninsured adults in the United States were >7 times as likely to report CRNA (OR =7.2; 95% CI, 5.0-10.5), and adults with public insurance (OR = 2.2; 95% CI, 1.4-3.5) and private insurance (OR = 2.2; 95% CI, 1.6-3.0) were >2 times as likely to report CRNA. CONCLUSIONS After stratifying by age and simultaneously adjusting for sex, household income, and chronic illness, large differences in CRNA were found between and within countries. Even in a compulsory prescription insurance system like that in Quebec, 4.4% of working-age adults reported CRNA. However, these rates were low compared with CRNA rates for working-age adults in the United States who lack any health insurance (43.3%).

Disparities in Unmet Need for Mental Health Services in the United States, 1997–2010

OBJECTIVES This study estimated unmet need for mental health services, identified population risk factors related to unmet need, and established baseline data to assess the impact of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act. METHODS National Health Interview Survey data (1997-2010) were analyzed. RESULTS Unmet need increased from 4.3 million in 1997 to 7.2 million in 2010. Rates in 2010 were about five times higher for uninsured than for privately insured persons. In a multivariate logistic model, likelihood was higher among children (age two to 17), working-age adults (age 18-64), women, uninsured persons, persons with low incomes, in fair or poor health, and with chronic conditions. CONCLUSIONS Unmet need is widespread, particularly among the uninsured. Expansion of coverage under the ACA, in conjunction with federal parity, should improve access, but ongoing monitoring of access is a research and policy priority.

Racial Disparities in VR Use and Job Placement Rates for Adults with Disabilities

Racial and ethnic disparities in access to vocational rehabilitation (VR) services and the efficacy of those services are a perennial concern of rehabilitation practitioners. This study used data from the Disability Supplement to the 1994 and 1995 National Health Interview Surveys (NHIS) to assess VR services utilization and employment outcomes among different racial and ethnic groups of working-age adults with disabilities. Racial disparities in the socioeconomic status of VR recipients were identified. Minorities received different types of VR services than did European Americans. European American VR recipients had the highest rates of competitive employment, whereas African American VR recipients were placed in noncompetitive employment more often than other racial groups. Policy and programming implications for VR professionals are discussed.

National Estimates of Vocational Service Utilization and Job Placement Rates for Adults With Mental Retardation

Data from the 1994 and 1995 Disability Supplements of the National Health Interview Survey (NHIS) were used to estimate rates of utilization of vocational services and examine employment outcomes for adults with disabilities who have received vocational services. Those living outside the formal long-term care system, and who were self or proxy identified as having mental retardation, were compared with other adults with disabilities. Analyses suggest that compared to other working-age persons with disabilities, adults with mental retardation (a) have a different population profile, (b) receive different types of services, (c) experience similar levels of satisfaction, (d) have much lower rates of competitive employment, and (e) are much more likely to be employed in segregated work settings. Research and policy implications of findings are discussed.

Trend and Pattern of Herb and Supplement Use in the United States: Results from the 2002, 2007, and 2012 National Health Interview Surveys

Background. In 1990s, complementary and alternative medicine (CAM), including use of herbs and supplements, gained popularity in the United States. However, more recent surveys suggest that demand for herbs and supplements has stabilized. Objective. This study examined the prevalence, patterns, and changes in herb and supplement use among the US adults, using the 2002, 2007, and 2012 National Health Interview Surveys (NHIS). Methods. Weighted population estimates were derived from three complementary and alternative medicine supplements to the NHIS. Prevalence rates for herb and supplement use were compared, using Wald chi-square tests to measure changes between years. Results. An estimated 40.6 million US adults reported herb and supplement use in 2012. However, the rate of herb and supplement use dropped from 18.9% in 2002 to 17.9% in 2007 and 2012 (P < 0.05). This decline in use was more pronounced among women, racial or ethnic minorities, and adults with low incomes. Conclusion. Herb and supplements use remains common in the USA, but adult use rates are on the decline. It is still important for health care providers to ask patients about herb and supplement use.

Job Discrimination in the Post-ADA Era Estimates from the 1994 and 1995 National Health Interview Surveys

The Americans with Disabilities Act (ADA) of 1990 was intended to facilitate employment, job retention, and workplace promotion of individuals with disabilities by protecting them from job discrimination. However, ongoing questions have been raised about the efficacy of the legislation. This study uses population data from the Disability Supplement to the 1994 and 1995 National Health Interview Surveys to assess rates of work discrimination among adults with disabilities ages 18 and older. The analysis suggests that nearly a 10th of all adults with disabilities who were in the workforce during the 5-year period immediately following passage of the ADA experienced some form of job discrimination. People who reported job discrimination were more likely to be younger and poorer and to have more severe disabilities than those who did not report any discrimination. About a third of the respondents who experienced discrimination left the workforce permanently. The implications of these findings for rehabilitation practice are discussed.

The prevalence of herb and dietary supplement use among children and adolescents in the United States: Results from the 2007 National Health Interview Survey.

OBJECTIVE The purpose of this study is to examine the national prevalence of herb and dietary supplement usage among children and adolescents age 4-17 in the United States, and to identify population factors associated with usage. METHODS Weighted population estimates are derived from the 2007 National Health Interview Child Complementary and Alternative Medicine Supplement (sample n=9417). Wald chi-square tests are used to compare factors associated with herb and dietary supplement use. RESULTS An estimated 2.9 million children and adolescents used herbs or dietary supplements in 2007. Pediatric herb and supplement use was more common among adolescents and non-Hispanic whites, and positively associated with parental education and household income. Children with activity limitations due to chronic health conditions, long-term prescription use, or relatively heavy use of physician services were also more likely to use herbal supplements. Echinacea and fish oil were most commonly used herbs and supplements. CONCLUSIONS Children in the US appear to use herbs or dietary supplements at a much lower rate than adults. This analysis shows a pattern of moderate and appropriate herb and supplement use in the pediatric population.