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Sandra K. Burge, PhD, Teresa L. Albright, MD and The Residency Research Network Of South Texas (RRNeST) Investigators

Sandra K. Burge is with the Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio. Teresa L. Albright is with the Corpus Christi Family Practice Residency Program, Corpus Christi, Texas. The RRNeST Investigators include: Jayne Morgan-Kidd, Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio; Robert Wood, School of Public Health, University of Texas, Houston; Daryl White, Family Practice Residency Program, Valley Baptist Medical Center, Harlingen; Juan J. Trevino, McAllen Family Practice Residency Program, McAllen; Ellen Bajorek, Family Practice Residency Program, Christus Santa Rosa Health Care, San Antonio; Leonides Cigarroa, Laredo Medical Group, Laredo; and Maurice Click, Laredo Medical Group.

Correspondence: Requests for reprints should be sent to: Sandra K. Burge, PhD, Department of Family and Community Medicine, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229 (e-mail: burge{at}uthscsa.edu).

	INTRODUCTION

TOP INTRODUCTION Methods Results Discussion References

 
Americans spend $27 billion out of pocket every year on complementary and alternative medicine (CAM).¹ Nearly all CAM users see physicians for health care,^2–4 but few mention their use of CAM to their doctors.^5–7 The "typical" CAM user is a young woman of European descent with higher than average income and education.^5,7–9 However, Keegan reported that many low-income Latinos use folk practitioners such as the curandero (healer), the yerbero (herbalist), the sobador (masseur), or practices such as spiritual healing rather than treatments offered by health clubs or health food stores.⁶ These patterns of CAM use are different than those of the majority population and deserve closer scrutiny.

The purpose of this brief was to understand CAM use by family practice patients in the unique cultural setting of south Texas. This brief estimates CAM use prevalence and assesses the influence of patient characteristics, including measures of ethnicity and acculturation, on CAM use.

	Methods

TOP INTRODUCTION Methods Results Discussion References

 
Investigators conducted a cross-sectional survey in the Residency Research Network of South Texas (RRNeST), a network of 6 family practice residency programs located in San Antonio, Corpus Christi, McAllen, Harlingen, and Laredo. Clinic staff surveyed 100 consecutive adult patients at each clinic site in fall 1998; 575 usable surveys were returned. The refusal rate was 22%; refusers were older than participants.

The self-administered survey elicited the reason for a patient’s visit, medication use, demographic information, and measures of ethnic background and acculturation,¹⁰ as well as CAM use during the 12 months prior to the survey. The CAM checklist included 23 items that addressed mind/body treatments, manual healing, herbal remedies, folk practices, and other treatments. Open-ended questions assessed specific products used. Surveys were available in both Spanish and English.

Bivariate and multivariate analyses examined characteristics of CAM users, comparing them with those who used no CAM whatsoever. Logistic regression analyses with forward stepwise inclusion determined the strongest predictors of CAM use while controlling for multicollinearity among the predictors.

	Results

TOP INTRODUCTION Methods Results Discussion References

 
Of the 575 respondents, most were Latino (80%), women (74%), high school graduates (69%), and married (57%); 69% of all respondents had private or government health insurance. The mean age of respondents was 41.5 years.

Table 1 displays responses to CAM survey items. Overall, 332 respondents (58%) used at least 1 of the treatments on this list. On average, CAM users checked 2.4 CAM items in the survey. Among CAM users, only 43% reported that they told their doctor about CAM use; 13% left this item blank.

Respondents also used prescriptions (62%) and over-the-counter medicines (77%) for their health problems. Older people used more prescription medicines (r = .473; P = .000), while younger people used more over-the-counter medicines (r = -.125; P = .003). In the 12 months prior to the survey, 7% of respondents used no products or treatments, while 33% used all 3 types: CAM as well as prescription and over-the-counter medicines.

Table 2 lists characteristics of CAM users and compares them to respondents who used no CAM whatsoever. Users of mind-body treatments and manual healing were more acculturated to mainstream US culture than CAM nonusers. In contrast, users of herbal remedies and folk practices were strongly affiliated to Latino culture, as were CAM nonusers. CAM users reported higher use of prescription and over-the-counter medications than CAM nonusers. Being unmarried was associated with mind-body and herbal remedies; being female was associated with use of herbal and folk remedies.

	Discussion

TOP INTRODUCTION Methods Results Discussion References

 
In south Texas, many Latino patients in family practices use CAM to improve their health, but most are not using treatments promoted by health clubs or health food stores. Non-Hispanic Whites were more likely to use those methods, in the form of mind-body and manual treatments, a finding consistent with other studies.^1,9,11 The strongest predictor of CAM use was use of other medicines, demonstrating that patients will seek several means to treat health problems. Use of mainstream (i.e., prescription and over-the-counter) products may be a marker of illness burden or propensity to seek treatment. Other investigators have likewise found that CAM users had poorer health status^11,12 and more frequent physician visits.^4,13,14 This study found that many patients do not disclose CAM use to their physicians,^2,6,7,15 a factor that increases the risk for treatment interactions. We encourage physicians to learn more about CAM products and treatments and to routinely screen all patients for CAM use.

	Acknowledgments

 
This study was supported by a grant from the Health Resources and Services Administration (5D32PE16016).

Human Participation Protection
This study was approved by the Institutional Review Board of the University of Texas Health Science Center in San Antonio.

	Footnotes

 
This study was developed by the entire team of RRNeST members: T. L. Albright, E. Bajorek, S. K. Burge, M. Click, L. Cigarroa, J. J. Trevino, and D. White as well as J. Morgan-Kidd and R. Wood. All 9 conceived the research question, developed the study protocol, interpreted the results, and reviewed drafts. T. L. Albright, E. Bajorek, M. Click, L. Cigarroa, J. J. Trevino, D. White, and J. Morgan-Kidd supervised data collection, while R. Wood and J. Morgan-Kidd managed the data files. S. K. Burge and R. Wood analyzed the data. S. K. Burge and T. L. Albright were the principal writers of the brief.

Peer Reviewed

Accepted for publication June 14, 2002.

	References

TOP INTRODUCTION Methods Results Discussion References

 
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2. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998; 279:1548–1553.[Abstract/Free Full Text]

3. Dello BM, Urciuoli O, Marietta P, Padoani W, De Leo D. Alternative medicine in a sample of 655 community-dwelling elderly. J Psychosom Res. 2001;50:147–154.[Medline]

4. Druss BG, Rohrbaugh R, Kosten T, Hoff R, Rosenheck RA. Use of alternative medicine in major depression. Psychiatr Serv. 1998;49:1397.[Free Full Text]

5. Drivdahl CE, Miser WF. The use of alternative health care by a family practice population. J Am Board Fam Pract. 1998;11:193–199.[Abstract]

6. Keegan L. Use of alternative therapies among Mexican Americans in the Texas Rio Grande Valley. J Holist Nurs. 1996;14:277–294.[Abstract]

7. 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;328:246–252.[Abstract/Free Full Text]

8. Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst. 2000;92:42–47.[Abstract/Free Full Text]

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10. Marin G, Sabogal F, Marin BV, et al. Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences. 1987;9:183–205.[Abstract]

11. Bausell RB, Lee WL, Berman BM. Demographic and health-related correlates to visits to complementary and alternative medical providers. Med Care. 2001;39:190–196.[Medline]

12. Ramos-Remus C, Gamez-Nava JI, Gonzalez-Lopez L, Skeith KJ, Perla-Navarro AV, Galvan-Villegas F, et al. Use of alternative therapies by patients with rheumatic disease in Guadalajara, Mexico: prevalence, beliefs, and expectations. Arthritis Care Res. 1998;11:411–418.[Medline]

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15. Gulla J, Singer AJ. Use of alternative therapies among emergency department patients. Ann Emerg Med. 2000;35:226–228.[Medline]

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