Yali A. Bair

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.

Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation.

Objective: This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity. Design: The Study of Womens Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing 6 years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time. Results: Approximately 80% of all participants had used some form of CAM at some time during the 6-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in use of CAM with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African American women, use of psychological remedies increased as they progressed through menopause. Conclusions: Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Womens personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.

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 Womens 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.

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.

Does “Mainstreaming” Guarantee Access to Care for Medicaid Recipients with Asthma?

OBJECTIVE: Recent reforms in the federal Medicaid program have attempted to integrate beneficiaries into the mainstream by providing them with managed care options. However, the effects of mainstreaming have not been systematically evaluated.DESIGN: Cross-sectional survey.SETTING/PARTICIPANTS: A sample of 478 adult, nonelderly asthmatics followed by a large Northern California medical group.MEASUREMENTS AND MAIN RESULTS: We examined differences in self-reported access by insurance status. Compared to patients with other forms of insurance, patiens covered by the state’s Medicaid program (Medi-Cal) were more likely to report access problems for asthma-related care, including difficulties in reaching a health care provider by telephone, obtaining a clinic appointment, and obtaining asthma medication. Adjusting for relevant clinical and sociodemographic variables, Medi-Ca1 patients were more likely to report at least one access problem compared to non-Medi-Ca1 patients (adjusted odds ratio [AOR], 3.34; 95% confidence interval [CI], 1.43 to 7.80). Patients reporting at least one access problem were also more likely to have made at least one asthma-related emergency department visit within the past year (AOR, 4.84; 95% CI, 2.41 to 9.72). Reported barriers to care did not translate into reduced patient satisfaction.CONCLUSIONS: Within this population of Medicaid patients, the provision of health insurance and care within the mainstream of an integrated health system was no guarantee of equal access as perceived by the patients themselves.

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.