Martha R. Harkey

Ethnic Differences in Use of Complementary and Alternative Medicine at Midlife: Longitudinal Results From SWAN Participants

OBJECTIVES We estimated the prevalence and longitudinal correlates of use of complementary and alternative medicine (CAM) at midlife among participants of the Study of Womens Health Across the Nation (SWAN). METHODS Multiple logistic regression was used to evaluate the relationship between baseline survey-reported symptoms and use of herbal, spiritual, and physical manipulation therapies 1 year later. RESULTS Almost half of all women had used CAM in the past year. Baseline psychological symptoms were associated with subsequent use of spiritual therapies among White and Chinese women. Baseline CAM use was a major predictor of subsequent use in White, Japanese, and Chinese women. CONCLUSIONS Baseline CAM use, rather than presence of symptoms, was the major predictor of subsequent CAM use. Premenopausal health behaviors are important determinants of choice of therapy during midlife.

Shosaiko-to and other Kampo (Japanese herbal) medicines: a review of their immunomodulatory activities

The use of alternative medicine, including consumption of herbal products and dietary supplements, has been increasing substantially both in the United States and in Western Europe. One area that is garnering increased attention is the use of Oriental Medicine including Kampo, or Japanese herbal medicine. Herein, we review representative examples of research available on the most common use of Kampo medicinals, namely to improve the immune response. We also provide an extensive background on the history of Kampo. There are more than 210 different Kampo formulae used in Japan and most uses of Kampo are to modulate the immune response, i.e. to improve immunity. We have extracted data on seven common Kampo medicinals, and the data are reviewed with respect to in vitro and in vivo activities for both humans and experimental animals; the ingredients as well as the problems with classification of these materials are presented. Research suggests that Kampo herbals are biologically active and may have therapeutic potential. While it is believed that Kampo medicines have few side effects, there is a paucity of data on their toxicity as well as a relative lack of knowledge of the bioactive constituents and potential drug interactions of these agents.

Use of conventional and complementary health care during the transition to menopause: Longitudinal results from the Study of Women's Health Across the Nation (SWAN)

Objective: Women beginning the transition to menopause now have access to complementary and alternative therapies (CAM) that were not universally available in the past. Little is known about the association between CAM use and the use of conventional health care during menopause. We investigated the longitudinal association between use of CAM therapies and utilization of conventional health care in a large, multiethnic sample of midlife women who were enrolled in the cohort phase of the Study of Womens Health Across the Nation (SWAN). Design: We used generalized estimating equations, repeated measures modeling to examine the association between CAM use and the yearly number of conventional health-care contacts, adjusting for relevant covariates, during a two-year period. CAM use was evaluated longitudinally as continuous, incident (no CAM use at baseline), sporadic, or no use during the study period. Results: Relative to nonusers, continuous CAM users had more conventional health-care contacts (β 0.14, 95% CI 0.06, 0.21). Incident users and sporadic users also showed an excess in conventional health-care contacts (β 0.14, CI 0.06, 0.22) and (β 0.09, CI 0.01, 0.16), respectively. Ethnicity was independently associated with health-care contacts. Relative to white women, Japanese women had fewer contacts (β −0.18, CI −0.31, −0.05). Conclusions: Despite being a generally healthy, well-educated and high-income population with good access to health care, CAM users were using more of both conventional and alternative health-care resources than women who did not use CAM. These findings have practical implications for conventional health-care practitioners, allied health professionals and CAM practitioners.

BAIR ET AL. RESPOND

We would like to thank Drs. Laws and Carballeira for their informative comments on our study of complementary and alternative medicine (CAM) use by women enrolled in the Study of Women’s Health Across the Nation (SWAN). Laws and Carballeira found, using a detailed, ethnically driven survey, that a much higher proportion of Latina women are using CAM than we reported in our study. We agree that using measures appropriate to specific ethnic groups is a valid and useful way to measure CAM use. However, in our study, we set out to describe differences in the use of broad categories of CAM among 5 very diverse ethnic groups across the nation (White, Black, Chinese, Japanese, and Hispanic, which consisted largely of Puerto Rican, Dominican, and Cuban women). It was not possible, in our preliminary study, to obtain detailed information about the CAM remedies used almost exclusively by 1 ethnic group. From an analytic standpoint, comparisons across ethnic groups would probably be somewhat problematic, given the small proportion of overlap in the use of some herbs and healing methods that are specific to particular ethnic groups. In 2002, we began gathering detailed, ethnically appropriate data at each of SWAN’s study sites. In the future, we plan to conduct ethnicity-specific analyses to describe more precisely the current trends in CAM use among women from diverse ethnic backgrounds as they experience the menopausal transition. We are pleased to note the increasingly frequent appearance of reports, such as those of Drs. Laws and Carballeiro, examing specific types of CAM use in specific subgroups of the population. The relatively high prevalence of CAM use underscores the need for increasing our understanding and consideration of the effects of these nonprescription remedies on health. The findings from these and other ongoing studies and trials should prove very useful in providing women with culturally appropriate care options during the menopause transition.