Review of the Use of Complementary and Alternative …Complementary and Alternative Medicine (CAM)...

TOPICS IN INTEGRATIVE HEALTH CARE [ISSN 2158-4222] – VOL 4(1) March 31, 2013

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Research

Review of the Use of Complementary and Alternative Medicine by Non-Hispanic Blacks

John Ward, DC, MA, MS1*, Kelley Humphries, MS2, Caroline Webb, MS, MLIS3, Michael Ramcharan, DC, MPH, MUA-C4 Address: 1Assistant Professor/Research Fellow, Department of Physiology and Chemistry, Texas Chiropractic College, Pasadena, TX, USA, 2Graduate Student Assistant, Texas Chiropractic College, Pasadena, TX, USA, 3Research Librarian, Texas Chiropractic College, Pasadena, TX, USA, 4Assistant Dean of Academic Affairs, Associate Professor, Texas Chiropractic College, Pasadena, Texas, USA. E-mail: John Ward, DC, MA, MS – [email protected] *Corresponding author Topics in Integrative Health Care 2013, Vol. 4(1) ID: 4.1003 Published on March 31, 2013 | Link to Document on the Web

Abstract

Introduction: Complementary and Alternative Medicine (CAM) has been on the rise over the past two decades. However, most CAM surveys demonstrate that blacks use CAM less often than whites. There is a shortage of review articles summarizing this discrepancy in use. Therefore a greater understanding of the true prevalence of different forms of CAM used by blacks is warranted. Methods: This review was generated through a three-step process. The first step involved a 2002-2011 literature search performed using key terms: African Americans, blacks, complementary therapies, prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies. Databases included the Index to Chiropractic Literature, PubMed, Alt Health Watch, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The intent was to find all peer-reviewed original articles about Non-Hispanic black usage of major forms of CAM during the intended time frame. The second step involved hand-searching numerous journal articles for relevant studies. The third step involved reference tracking of the articles that had already been discovered to find new articles. Following screening, articles were then grouped thematically for discussion purposes as follows: acupuncture, chiropractic, herbal medicine, massage therapy, mind-body therapies, and prayer as forms of CAM, as well as CAM use articles for specific health conditions.

mailto:[email protected]

http://www.tihcij.com/Articles/Review-of-the-Use-of-Complementary-and-Alternative-Medicine-by-Non-Hispanic-Blacks.aspx?id=0000383


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Results: Thirty-six original articles met the inclusion criteria. This was composed of thirty-five original surveys and one focus-group analysis. Conclusion: The existing evidence suggests that Non-Hispanic blacks use CAM significantly less than whites, with the exception of prayer. The reason for this difference should be further investigated.

Introduction

Complementary and Alternative Medicine (CAM) has steadily been on the rise over the past two decades.1-4 In the Institute of Medicine’s 2005 report on CAM they stated that additional studies are needed to better understand CAM therapies that are used by Americans and which populations use them.5 In general, whites are more prone to seek out CAM treatments and therapies in comparison to other ethnic groups. This is especially true when compared to blacks. For example, one such study found that 43.1% of white adults sought out CAM treatments and therapies in comparison to 25.5% of blacks.2 The most prevalent reasons presented as to why whites used CAM more often than blacks have been: higher education, increased annual income, and a more positive perception of the healthcare system in general.1-4 To our knowledge there has only been one review article summarizing blacks’ use of CAM.6 Unfortunately, the article only focused on one form of CAM, religion. Additionally, there is minimal research that provides an explanation as to why blacks utilize CAM less often.1-4 Thus a more robust review is needed to develop a clearer picture of black use of multiple forms of CAM. The purpose of this systematic review is to summarize the usage of prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies by Non-Hispanic blacks.

Methods

This study was deemed exempt by Texas Chiropractic College’s IRB.

Search Strategy

This review article was generated through a three-step process. We attempted to identify all peer-reviewed original articles about Non-Hispanic black usage of major forms of CAM during the intended time frame in North America. The first step involved a literature search performed using key terms: African Americans, blacks, complementary therapies, prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies. This search covered a ten-year time frame from Jan 2002-Dec 2011 in English only. Databases involved included the Index to Chiropractic Literature, PubMed, Alt Health Watch, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Article inclusion criteria were: articles discussing the intended forms of CAM used by blacks, publication during 10-year time frame, English language, survey or focus group studies, populations included were


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North American only, and proportions of blacks using a given form of CAM must be specified. Article exclusion criteria were: abstracts only, letters/editorials, review articles, linkset analysis, papers which had methodology descriptions inadequate to interpret their results, and case reports. The following search terms were utilized for the Index to Chiropractic Literature: ("African Americans" OR blacks) AND (“Complementary Therapies” OR prayer OR acupuncture OR massage therapy OR “Herbal Medicine” OR "Mind-Body Therapies") with “peer reviewed citations” selected. The following search terms were for PubMed: ("African Americans"[MeSH] OR blacks) AND (“Complementary Therapies” [MeSH] OR prayer OR chiropractic OR acupuncture OR massage therapy OR “Herbal Medicine” [MeSH] OR "Mind-Body Therapies"[MeSH]) The following search terms were used for Alt Health Watch and CINAHL: ("African Americans" OR blacks) AND (“Complementary Therapies” OR prayer OR chiropractic OR acupuncture OR massage therapy OR “Herbal Medicine” OR "Mind-Body Therapies") The second step involved hand-searching the following journals for relevant articles:

The Journal of Alternative and Complementary Medicine Focus on Alternative and Complementary Therapies Alternative and Complementary Therapies Alternative Medicine Review Alternative Therapies in Health and Medicine Journal of Manipulative and Physiological Therapeutics

The third step of the literature search involved reference tracking. This was the process of reviewing the references of all of the articles that were found in the two original steps of our process.

Review Strategy and Grouping

Following this step, all papers were screened as outlined in Fig. 1. At the conclusion of screening a total of 36 papers remained. Due to the limited number of papers, and in some cases overlapping data sets, on the use of CAM by non-Hispanic blacks, no attempt to rate these papers through a systematic mechanism was performed. Articles were then grouped by CAM practices as follows: prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies. The following study characteristics were extracted from each article: first author, study design, black and white participant count, major findings, and whether whites or blacks used that given form of CAM more often. Non-Hispanic blacks will be referred to as blacks, and African Americans, who are considered a sub-classification of blacks, will be abbreviated as AA as they were described by each original author.


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Figure 1: Journal screening process.

Results

The majority of the comparisons in this study demonstrated that blacks use CAM less than whites. Table 1 demonstrates that 7 articles found blacks used religion more often than whites. Five demonstrated a greater than 10% difference in favor of blacks using this form of CAM. Contrasting this occurrence, one article described white dominance in the use of religion as a form of CAM over blacks with a difference greater than 10%.


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Table 1 Non-Hispanic black use of prayer.

Authors, Data source Black White Main results Lead

publication year,

n, sex, age

N, sex, age %1

citation

Cuellar et al. Convenience sample 40 143

83.8% of whites used prayer as a form of CAM B

2003 (7) survey both both 90.0% of AAs used prayer as a form of CAM

(50+ yrs) (50+ yrs)

Dessio et al. Cross-sectional survey 812 none

43% of AA women reported using spirituality for health reasons NA

2004 (8) females only in the past year

(18+ yrs) Factors associated with the use of religion/spirituality as a form of CAM

in the past year were: income ($40,000-60,000), college education

or higher, age (37-56 years-of-age), and worse health status

Conboy et al. 1997-1998 National 199 1,636

77.0% of whites used self-prayer as a form of CAM W*

2005 (9) Sample both both 9.6% of blacks used self-prayer as a form of CAM

(18+ yrs) (18+ yrs)

Goldstein et al.

2001 California Health 961 3,660

55.5% of whites reported CAM use in general B*

2005 (10) Interview Survey both both 5.8% of AAs reported CAM use in general

Complementary and (18+ yrs) (18+ yrs)

44.0% of whites used prayer as a form of CAM

Alternative Medicine 66.0% of AAs used prayer as a form of CAM

supplement (CHIS-CAM)

Hsiao et al. 2001 California Health 961 3,660

32.4% of whites reported others prayed for their health as a form B*

2006 (11) Interview Survey both both of CAM


56.3% of AAs reported others prayed for their health as a form of CAM

Alternative Medicine


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Kronenberg Cross-sectional 1,081 757 37.1% of non-Hispanic whites used spirituality/religion/prayer as a B

et al. telephone survey females only

females only form of CAM

2006 (12) (18+ yrs) (18+ yrs) 42.8% of AAs used spirituality/religion/prayer as a form of CAM

Brown et al. 2002 National Health 4,256 none

67.6% of AAs reported using CAM in the past 12 months NA

2007 (13) Interview Survey (NHIS) both

CAM users were more likely female, college-educated, older, and insured

(18+ yrs) 60.7% of AAs used prayer in the past 12 months as a form of CAM

Xu & Farrell Medical Expenditure 7,196 27,584

25.4% of non-Hispanic whites used prayer as a form of CAM B*

2007 (14) Panel Survey (MEPS) both both

48.9% of blacks used prayer as a form of CAM

(18+ yrs) (18+ yrs)

Wilkinson et al.

2002 National Health 3,620 24,940

43.3% of whites prayed for their health within the past 12 months B*

2008 (15) Interview Survey (NHIS) both both

62.8% of blacks prayed for their health within the past 12 months

(18+ yrs) (18+ yrs) Black women were 11% more likely to have visited a primary care physician

that same year if they reported praying regularly

Participants that prayed were more likely to be female, over the age of 58,

and black


If prayer for health reasons was included in the definition of CAM then NA


67.6% of AAs reported CAM use in the past 12 months

(18+ yrs) If prayer for health reasons was not included in the definition of CAM then

27.0% of AAs reported CAM use in the past 12 months

The following variables were predictors of CAM use: middle-aged to older,

female gender, and a high school or greater education

Barner et al. 2002 National 2,952 none 33.3% of AAs used prayer as a form of NA


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Health prevention-based CAM


(18+ yrs)

Upchurch et al.

2002 National Health 879 3,933

49.8% of whites used prayer for health reasons as a form of CAM B*

2010 (18) Interview Survey (NHIS)

females only

females only

77.4% of blacks used prayer for health reasons as a form of CAM

(40-59 yrs)

(40-59 yrs)

1 Lead % = a given form of CAM is used more by one ethnicity over the other. *= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored.

W= Whites use a given form of CAM more than blacks. B= Blacks use a given form of CAM more than whites.

Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.

NA= article only discussed black use of CAM.

Regarding herbal medicine use, Table 2 demonstrates that 12 articles found 2hites to user herbal medicine more than blacks and 5 articles found that blacks used it more often. Upon close review of the white lead in herbal medicine use as a form of CAM, 4 articles demonstrated greater than a 10% difference in favor of whites using herbal medicine over blacks while two articles indicated that blacks used herbal medicine more frequently than whites.

Table 2 Non-Hispanic black use of herbal medicine.


publication year,

n, sex, age

N, sex, age %1

citation

Bair et al. Study of Women's health 941 1,557

18.6% of whites used herbal products as a form of CAM W

2002 (19) Across the Nation women only

women only

14.9% of AAs used herbal products as a form of CAM

(SWAN) (42-52 yrs)

(42-52 yrs)


23.2% of Caucasian Americans used herbs as a form of CAM B

2003 (7) survey both both 25.0% of AAs used herbs as a form of CAM

(50+ yrs) (50+ yrs)


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Mackenzie et al. 1995 National 1,048 1,114

12% of whites reported herbal medicine use as a form of CAM B

2003 (20) Comparative Survey of both both

19% of blacks/AAs reported herbal medicine use as a form of CAM

Minority Health Care of (18+ yrs) (18+ yrs)

the Commonwealth Fund

Cherniack & Pan General survey 33 57

54% of whites reported using herbal products as a form of CAM B*

2004 (21) both both 79% of AAs reported using herbal products as a form of CAM

(60+ yrs) (60+ yrs)

Kuo et al. Southern Primary-care 136 68

77.0% of whites reported wanting information on the effectiveness of herbal W

2004 (22) Urban Research both both products

Network (SPUR-Net) (18+ yrs) (18+ yrs)

64.0% of AAs reported wanting information on the effectiveness of herbal

products

66.7% of whites reported using herbal products to their physician/

pharmacist

44.7% of AAs reported using herbal products to their physician/pharmacist

14.7% of whites reported receiving information on herbal product

effectiveness from their physician

8.8% of AAs reported receiving information on herbal product

effectiveness from their physician

Conboy et al. 1997-1998 National 199 1,636

78.0% of whites used herbs as a form of CAM W*

2005 (9) Sample both both 5.5% of blacks used herbs as a form of CAM

(18+ yrs) (18+ yrs)

Goldstein et al.


55.5% of whites reported CAM use in general W



83.0% of whites reported using at least two dietary supplements (vitamin A,

Alternative vitamin B, vitamin C, vitamin D, vitamin E,


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Medicine lycopene, folic acid, calcium,


selenium, zinc, glucosamine, Echinacea, fish oil, garlic pills, green tea,

Ginkgo biloba, melatonin, valerian, soy products, black cohosh, DHEA,

ma huang, saw palmetto, shark cartilage, dong quai, ginseng, St. John's

wort, PC-SPES, and mistletoe) as a form of CAM in the past 12 months

81.8% of AAs reported using at least two dietary supplements as a form

of CAM in the past 12 months

Graham et al. 2002 National Health 3,694 23,749

19.2% of non-Hispanic whites used herbal medicine as a form of CAM W


14.1% of non-Hispanic blacks used herbal medicine as a form of CAM

(18+ yrs) (18+ yrs)

Ness et al. Sub-sample of the 2000 132 868

21% of non-Hispanic whites used herbal supplements as a form of CAM W*

2004 (24) wave of the Health and both both

10% of non-Hispanic blacks used herbal supplements as a form of CAM

Retirement Study (52+ yrs) (52+ yrs)


37.8% of whites used green tea as a form of CAM B

2006 (11) Interview Survey both both 39.5% of AAs used green tea as a form of CAM


9.7% of whites used garlic pills as a form of CAM


16.3% of AAs used garlic pills as a form of CAM


15.6% of whites used ginseng as a form of CAM

23.5% of AAs used ginseng as a form of CAM

Kelley et al. Slone Survey data 1,174 10,372 18% of whites reported herbal product use in the week before the survey W

2006 (25) both both as a form of CAM

(18+ yrs) (18+ yrs) 11% of AAs reported herbal product use in the week before the survey

as a form of CAM

Kronenberg Cross-sectional 1,081 757 16.7% of non-Hispanic Whites used medicinal herbs and teas as a form W


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et al. telephone survey females only

females only of CAM

2006 (12) (18+ yrs) (18+ yrs) 14.1% of AAs used medicinal herbs and teas as a form of CAM

Yoon General survey 58 85 44.7% of whites reported herbal product use in the past 12 months W*

2006 (26) females only

females only

34.5% of AAs reported herbal product use in the past 12 months

(65+ yrs) (65+ yrs)

Bardia et al. 2002 National Health 49 495

68.0% of whites reported herbal product use (including Echinacea) draw


76.2% of blacks reported herbal product use (including Echinacea)

(18+ yrs) (18+ yrs) 25.8% of whites reported herbal product use (excluding Echinacea)

16.3% of blacks reported herbal product use (excluding Echinacea)

Black adults were significantly less likely to consume herbs than their racial

counterparts (with the exception of Echinacea)


67.6% of AAs reported using CAM in the past 12 months na



(18+ yrs) 14.2% of AAs used herbal products in the past 12 months as a form of CAM

Gardiner et al.

2002 National Health 14 64

29.7% of non-Hispanic whites reported herbal product or non-vitamin/mineral B*


supplement use (melatonin, bee pollen, fish oil, glucosamine, chondroitin,

(18-30 yrs)

(18-30 yrs)

progesterone cream, or s-adenosylmethionine)

92.9% of non-Hispanic blacks reported herbal product or non-vitamin/

mineral supplement use

Kennedy et al.

2002 National Health 2,901 19,375

37.4% of whites reported herbal product use to their physician W


31.2% of blacks/AAs reported herbal product use to their physician

(18+ yrs) (18+ yrs)


34.4% of non-Hispanic whites used herbal products as a form of CAM W*


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18.8% of Blacks used herbal products as a form of CAM

(18+ yrs) (18+ yrs)

Barner et al. 2002 National Health 2,952 none

50.4% of AAs used herbal medicine as a form of prevention-based CAM NA


(18+ yrs)

Upchurch et al.


26.2% of whites used herbal products as a form of CAM W


females only

females only

19.5% of blacks used herbal products as a form of CAM

(40-59 yrs)

(40-59 yrs)





Concerning the use of massage, Table 3 shows that 8 articles found that whites used massage more often than blacks, and no articles found that blacks used massage more often than whites. Three of the articles demonstrated a greater than 10% difference in favor of whites.

Table 3 Non-Hispanic black use of massage.


publication year,

n, sex, age

N, sex, age %1

citation


20.2% of whites used physical methods (described as "massage, W


women only

acupressure, or acupuncture") as a form of CAM

(SWAN) (42-52 yrs)

(42-52 yrs) 11.7% of AAs used physical methods


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11.3% of Caucasian Americans used massage therapy as a form of CAM W

2003 (7) survey both both 10.0% of AAs used massage therapy as a form of CAM

(50+ yrs) (50+ yrs)

Conboy et al. 1997-1998 National 199 1,636 76.0% of whites used massage as a form of CAM W*

2005 (9) Sample both both 6.6% of blacks used massage as a form of CAM

(18+ yrs) (18+ yrs)

Goldstein et al.





18.2% of whites used a massage therapist as a form of CAM


12.9% of AAs used a massage therapist as a form of CAM



29.4% of whites used a massage therapist as a form of CAM W*

2006 (11) Interview Survey both both 5.7% of AAs used a massage therapist as a form of CAM




Kronenberg Cross-sectional 1,081 757 13.1% of non-Hispanic whites used manual therapies (massage and W

et al. 2006 (12) telephone survey

females only

females only acupressure) as a form of CAM

(18+ yrs) (18+ yrs) 7.2% of AAs used manual therapies as a form of CAM


67.6% of AAs reported using CAM in the past 12 months na



(18+ yrs) 2.4% of AAs used massage in the past 12 months as a form of CAM


36.6% of non-Hispanic whites used massage as a form of CAM W*


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20.7% of blacks used massage as a form of CAM

(18+ yrs) (18+ yrs)


46.8% of AAs used massage as a form of prevention-based CAM NA


(18+ yrs)

Upchurch et al.


8.5% of whites used massage as a form of CAM W


females only

females only

3.1% of blacks used massage as a form of CAM

(40-59 yrs)

(40-59 yrs)





Table 4 demonstrates that when observing the difference in chiropractic use, 13 articles showed that whites use chiropractic more often than blacks, with no articles showing that blacks used chiropractic care more often than whites. Five articles demonstrated greater than 10% difference between the use pattern between whites and blacks.

Table 4 Non-Hispanic black use of chiropractic.


publication year,

n, sex, age

N, sex, age %1

citation


19.0% of Caucasian Americans used chiropractic as a form of CAM W*

2003 (7) survey both both 7.5% of AAs used chiropractic as a form of CAM

(50+ yrs) (50+ yrs)


13% of whites reported chiropractic as a form of CAM W


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2003 (20) Comparative Survey of both both

5% of blacks/AAs reported chiropractic as a form of CAM



Conboy et al. 1997-1998 National 199 1,636 85% of whites used chiropractic as a form of CAM W*

2005 (9) Sample both both 3.9% of blacks used chiropractic as a form of CAM

(18+ yrs) (18+ yrs)

Goldstein et al.





16.3% of whites used chiropractic as a form of CAM


10.0% of AAs used chiropractic as a form of CAM



8.8% of non-Hispanic whites used chiropractic as a form of CAM W


2.7% of non-Hispanic blacks used chiropractic as a form of CAM

(18+ yrs) (18+ yrs)

Ness et al. Sub-sample of the 2000 132 868

49% of non-Hispanic whites visited chiropractors as a form of CAM W*

2005 (24) wave of the Health and both both

25% of non-Hispanic blacks visited chiropractors as a form of CAM

Retirement Study (52+ yrs) (52+ yrs)


44.6% of whites reported using chiropractic as a form of CAM W*

2006 (11) Interview Survey both both 33.0% of AAs reported using chiropractic as a form of CAM




Kronenberg et al. Cross-sectional 1,081 757

16.2% of non-Hispanic whites used chiropractic as a form of CAM W*


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2006 (12) telephone survey females only

females only

5.9% of AAs used chiropractic as a form of CAM

(18+ yrs) (18+ yrs)





(18+ yrs) 2.8% of AAs used chiropractic in the past 12 months as a form of CAM

Wolinsky et al.

Survey on Assets and 388 3,773

AAs demonstrated an Adjusted Odds Ratio (AOR) of 0.239 of seeing a W

2007 (30) Health Dynamics both both chiropractor, making them substantially less likely than whites to see

Among the Oldest Old (70+ yrs) (70+ yrs) them

(AHEAD)


14.5% of Non-Hispanic whites used chiropractic as a form of CAM W


6.1% of blacks used chiropractic as a form of CAM

(18+ yrs) (18+ yrs)

Ndetan et al. 2005 National Health 2,764 15,608

3.4% of white participants only saw a chiropractor as a form of healthcare W


as opposed to participants that only saw a MD.

(18+ yrs) (18+ yrs) 1.3% of black participants only saw a chiropractor as a form of healthcare

as opposed to participants that only saw a MD.


5.7% of AAs visited a chiropractor as a form of prevention-based CAM NA


(18+ yrs)

Upchurch et al.


11.2% of whites used chiropractic as a form of CAM W


females only

females only

3.1% of blacks used chiropractic as a form of CAM

(40-59 yrs)

(40-59 yrs)

Weigel et al. Survey on Assets and 562 4,673

14.1% of whites report long-term chiropractic use over a 15-year period W


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2010 (32) Health Dynamics Among both both

3.3% of AAs report long-term chiropractic use over a 15-year period

the Oldest Old (AHEAD) (65+ yrs) (65+ yrs)

+1993-2007 Medicare

claims 1 Lead % = a given form of CAM is used more by one ethnicity over the other. *= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored.




Reviewing the use of acupuncture, Table 5 demonstrates that 9 articles illustrate that whites use acupuncture more often than blacks, with no articles showing the opposite. Only one of the nine articles showed greater than 10% difference between white and black use of acupuncture.

Table 5 Non-Hispanic black use of acupuncture.


publication year,

n, sex, age

N, sex, age %1

citation


20.2% of whites used physical methods (described as "massage, W


women only

acupressure, or acupuncture") as a form of CAM

(SWAN) (42-52 yrs)

(42-52 yrs)

11.7% of AAs used physical methods as a form of CAM


0.7% of Caucasian Americans used acupuncture as a form of CAM W

2003 (7) survey both both 0.0% of AAs used acupuncture as a form of CAM

(50+ yrs) (50+ yrs)


1% of whites reported acupuncture as a form of CAM draw

2003 (20) Comparative Survey both both 1% of blacks/AAs reported acupuncture


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of as a form of CAM



Conboy et al. 1997-1998 National 199 1,636 86.0% of whites used acupuncture as a form of CAM W*

2005 (9) Sample both both 1.7% of blacks used acupuncture as a form of CAM

(18+ yrs) (18+ yrs)

Goldstein et al.





3.1% of whites used acupuncture as a form of CAM


2.4% of AAs used acupuncture as a form of CAM



1.0% of non-Hispanic whites used acupuncture as a form of CAM W


0.7% of non-Hispanic blacks used acupuncture as a form of CAM

(18+ yrs) (18+ yrs)


12.2% of whites reported using acupuncture as a form of CAM W

2006 (11) Interview Survey both both 9.0% of AAs reported using acupuncture as a form of CAM




Kronenberg et al. Cross-sectional 1,081 757


2006 (12) telephone survey females only

females only

0.9% of AAs used acupuncture as a form of CAM

(18+ yrs) (18+ yrs)



2007 (13) Interview Survey both CAM users were more likely female,


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(NHIS) college-educated, older, and insured

(18+ yrs) 0.7% of AAs used acupuncture in the past 12 months as a form of CAM




6.9% of blacks used acupuncture as a form of CAM

(18+ yrs) (18+ yrs)


23.2% of AAs visited an acupuncturist as a form of prevention-based CAM NA


(18+ yrs)

Upchurch et al.


1.7% of whites used acupuncture as a form of CAM W


females only

females only

0.4% of blacks used acupuncture as a form of CAM

(40-59 yrs)

(40-59 yrs)





Table 6 summarizes the use of mind-body therapies. Five articles demonstrated that whites used this form of CAM more often than blacks, and none showed the opposite. Two of the five articles demonstrated greater than 10% difference between blacks and whites.

Table 6 Non-Hispanic black use of mind-body therapies.


publication year,

n, sex, age

N, sex, age %1

citation


29.6% of whites used psychological interventions (such as W*


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2002 (19) Across the Nation females only

females only

"meditation, mental imagery, or relaxation techniques") as a

(SWAN) (42-52 yrs)

(42-52 yrs) form of CAM

11.6% of AAs used psychological interventions


22.5% of Caucasian Americans used meditation as a form of CAM draw

2003 (7) survey both both 30.0% of AAs used meditation as a form of CAM

(50+ yrs) (50+ yrs) 0.0% of Caucasian Americans used biofeedback as a form of CAM

5.0% of AAs used biofeedback as a form of CAM

2.8% of Caucasian Americans used yoga as a form of CAM

2.5% of AAs used yoga as a form of CAM

0.7% of Caucasian Americans used hypnosis as a form of CAM

0.0% of AAs used hypnosis as a form of CAM

1.4% of Caucasian Americans used T'ai chi as a form of CAM

0.0% of AAs used T'ai chi as a form of CAM

Conboy et al. 1997-1998 National 199 1,636 77.0% of whites used relaxation as a form of CAM W*

2005 (9) Sample both both 6.9% of blacks used relaxation as a form of CAM

(18+ yrs) (18+ yrs) 82.0% of whites used imagery as a form of CAM

2.3% of blacks used imagery as a form of CAM

86.0% of whites used biofeedback as a form of CAM

4.6% of blacks used biofeedback as a form of CAM

84.0% of whites used hypnosis as a form of CAM

1.8% of blacks used hypnosis as a form of CAM

78.0% of whites used yoga as a form of CAM


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4.9% of blacks used yoga as a form of CAM

Goldstein et al.





24.9% of whites used mind-body techniques (guided imagery,


meditation, hypnosis, biofeedback) as a form of CAM


19.8% of AAs used mind-body techniques as a form of CAM


0.2% of non-Hispanic whites used biofeedback as a form of CAM W


0.1% of non-Hispanic blacks used biofeedback as a form of CAM

(18+ yrs) (18+ yrs) 0.3% of non-Hispanic whites used hypnosis as a form of CAM

0.2% of non-Hispanic blacks used hypnosis as a form of CAM

14.8% of non-Hispanic whites used relaxation techniques as CAM

13.6% of non-Hispanic blacks used relaxation techniques as CAM

1.2% of non-Hispanic whites used T'ai chi as a form of CAM

1.1% of non-Hispanic blacks used T'ai chi as a form of CAM

5.6% of non-Hispanic whites used yoga as a form of CAM

2.6% of non-Hispanic blacks used yoga as a form of CAM

Kronenberg Cross-sectional 1,081 757 13.2% of non-Hispanic whites used mind-body practices (yoga, W

et al. 2006 (12) telephone survey

females only

females only

meditation, T'ai chi, Chi gong) as a form of CAM

(18+ yrs) (18+ yrs) 5.0% of AAs used mind-body practices as a form of CAM





(18+ yrs) 3.2% of AAs used yoga or T'ai chi in the past 12 months as a form of CAM


21 | P a g e

0.2% of AAs used hypnosis in the past 12 months as a form of CAM

13.6% of AAs used relaxation in the past 12 months as a form of CAM

0.1% of AAs used biofeedback in the past 12 months as a form of CAM


1.9% of non-Hispanic whites used biofeedback as a form of CAM draw



(18+ yrs) (18+ yrs) 1.2% of non-Hispanic whites used hypnosis as a form of CAM

2.7% of blacks used hypnosis as a form of CAM

8.9% of non-Hispanic whites used meditation as a form of CAM

8.0% of blacks used meditation as a form of CAM


83.4% of AAs used yoga or T'ai chi as a form of prevention-based CAM NA


18.1% of AAs used biofeedback as a form of prevention-based CAM

(18+ yrs) 76.3% of AAs used relaxation as a form of prevention-based CAM

Upchurch et al.


11.5% of whites used meditation as a form of CAM draw


females only

females only

9.2% of blacks used meditation as a form of CAM

(40-59 yrs)

(40-59 yrs)

6.1% of whites used yoga as a form of CAM

4.6% of blacks used yoga as a form of CAM

1.3% of whites used T'ai chi as a form of CAM

1.0% of blacks used T'ai chi as a form of CAM

0.2% of whites used biofeedback as a form of CAM


1 Lead % = a given form of CAM is used more by one ethnicity over the other. *= a greater than 10% difference between whites and blacks for the primary chart dependent


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variable monitored.




There were 11 articles focusing on the use by blacks of CAM for specific health conditions. Table 7 summarizes the chief details of five articles focused on diabetes, two on respiratory conditions, two on mental illness, one on chronic conditions, and one on AIDS.

Table 7 Non-Hispanic black use of CAM for specific disease states.

Authors, Disease state Data source Black White Main results Lead

publication year,

n, sex, age

N, sex, age %1

citation Black White

Bell et al. CAM use 2002 National Health 1,225 7,895

33.2% of non-Hispanic whites with diabetes report W

2006 (33) for diabetes Interview Survey (NHIS) both both using CAM

(18+ yrs) (18+ yrs)

28.8% of non-Hispanic blacks with diabetes report

using CAM

39.5% of non-Hispanic whites without diabetes report

using CAM

29.8% of non-Hispanic blacks without diabetes report

using CAM

Garrow & Egede CAM use


48.4% of white diabetics report CAM use for diabetes W*

2006 (34) for diabetes Interview Survey (NHIS) both both

34.6% of black diabetics report CAM use for diabetes

(18+ yrs) (18+ yrs)

George et al. CAM use General survey 28 none 66% of AA asthmatics NA


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reported using prayer as a

2006 (35) for asthma both form of CAM

(all)

36% of AA asthmatics reported using relaxation as a

form of CAM

7% of AA asthmatics reported using biofeedback as

a form of CAM

7% of AA asthmatics reported using yoga as a

form of CAM

4% of AA asthmatics reported using meditation as a

form of CAM

7% of AA asthmatics reported using chiropractic

care as a form of CAM

Grzywacz et al. CAM use Evaluating Long-term 220 297

The AA unadjusted odds ratio of using food remedies B

2006 (36) for diabetes Diabetes Self-management both both

was 1.90 in relation to whites as a form of CAM

among Elder Rural adults

(65+ yrs) (65+ yrs)

(ELDER) survey

Jones et al. CAM use Descriptive study focus 68 none

The most common alternative therapies used for NA

2006 (37) for diabetes group both diabetes are prayer, diet-based therapies, and

(21+ yrs) natural products

Schoenberg et al. CAM use General survey 20 20

5% of rural white diabetics report herbal CAM use B

2006 (38) for diabetes both both for diabetes

(50+ yrs) (50+ yrs)

10% of AA diabetics report herbal CAM use

for diabetes

0% of rural white diabetics


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report tea CAM use

for diabetes

5% of AA diabetics report tea CAM use for diabetes

Bazargan et al. CAM use General survey 85 none 42% of depressed AAs report frequent use of CAM NA

2008 (39) for depression both

(all)

Mehta et al. CAM use 2002 National Health 2,901 19,375

35% of non-Hispanic whites reported herbal product W

2008 (40) for chronic Interview Survey (NHIS) both both use to their physician

conditions (18+ yrs) (18+ yrs)

31% of non-Hispanic blacks reported herbal product

use to their physician

Hipps et al. CAM use for General survey 41 none AAs that consumed Breathe Easy® herbal tea 4 NA

2009 (41) rhinosinusitus both times a day changed their baseline SF-36 form

(35+ yrs) score up 9% after 6 weeks

Woodward et al. CAM use for National Survey of 631 1,393

39% of whites used CAM for mood, anxiety, or W*

2009 (42) mood, anxiety, American Life (NSAL) and both both substance disorders

and substance National Comorbidity

(18+ yrs) (18+ yrs)

24% of AAs used CAM for mood, anxiety, or

abuse Survey-Replication (NCS-R) substance disorders

Owen-Smith et al. CAM use by General survey 182 none

4.1% of AA AIDS patients reported using herbal NA

2010 (43) AAs with both products as a form of CAM on a regular basis

AIDS (all) 3.4% of AA AIDS patients reported using chiropractic

as a form of CAM on a regular basis

2.0% of AA AIDS patients reported using massage


25.2% of AA AIDS patients


25 | P a g e

reported using meditation


2.7% of AA AIDS patients reported using yoga

a form of CAM on a regular basis

1.4% of AA AIDS patients reported using T'ai chi


0.7% of AA AIDS patients reported using acupuncture


52.4% of AA AIDS patients reported using prayer


1Lead % = a given form of CAM is used more by one ethnicity over the other. *= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored.



NA= the journal only discussed black use of CAM.

Discussion

CAM demographic studies show that most users of CAM are white, between the ages of 35 to 49, possess some level of college education, and have a household income over $50,000.9 Studies specifically focusing on blacks have found that CAM users are generally older, with an average age of 43.3; they are more likely to be female, have a college education, and possess insurance.13,44,45 Black participants who regularly use CAM report that it gives them a sense of power over their own health.45 A common reason for trying CAM among blacks is having another family member who has used it.44 Prayer has been found to be the most utilized form of CAM.46 Studies have shown distinct differences in the rates of morbidity and mortality between individuals who classify themselves as religious compared to those who do not.6 Religion appears to be very important to blacks. Church attendance, particularly among AA men, has been found to be a significant social support outlet to reduce stress.47 Decreasing stress level can have a beneficial impact on blood cortisol, a hormone that when released in excess can


26 | P a g e

suppress immune function.48 Some studies on religiousness among AAs have had particularly startling results. For example, one article found that the average life expectancy for a 20-year old AA was 55.3 years for non-churchgoers and 62.9 years for churchgoers who attended church more than once per week.49 Changes like this reflect the powerful impact religion may have among blacks. Various forms of herbal products have been found to be commonly used in treating health conditions. For example, echinacea has been marketed to treat the common cold. Ginseng has been proposed to improve physical and cognitive performance. Garlic has shown some capability of lowering blood cholesterol level.50 Overall whites have been found to use herbal products more than blacks. The difference in pattern use, however, is debatable and thus likely is small. Massage therapy is one of the most commonly used CAM therapies in North America. The health benefits of massage therapy have been an area that has not been extensively researched. Existing studies suggest massage therapy may have analgesic effects which reduce stress and result in positive patient outcomes in those suffering from acute musculoskeletal conditions.1,2,4 All articles in this review demonstrated that whites use massage as a form of CAM more often than blacks. The obstacles to massage use by blacks should be investigated. All articles comparing chiropractic use by blacks to that of whites demonstrated that whites use chiropractic more often. In many instances whites used chiropractic at least twice as often as blacks.7,9,12,14,18,20,23,31,32 Some have attributed this difference to the perception of discrepancies of healthcare treatment by blacks, lower average educational levels of blacks compared to whites, and the lack of accessibility to chiropractors in black communities.7,16,17,23 Additional study is warranted to determine why blacks use chiropractic care less often than whites. Acupuncture has been used to treat a wide variety of conditions including: knee osteoarthritis, headaches, nausea during pregnancy, low back pain, chronic neck pain, and dysmenorrhea.51,52 Surveys have demonstrated that often patients seek out acupuncturists because conventional medical care has not helped them adequately.53 This review article illustrated the trend that whites use acupuncture more than blacks in all cases. However, the difference between black and white use of acupuncture was often less than 3%. Some techniques utilized as mind-body therapies are deep breathing, imagery, hypnotherapy, progressive relaxation, qi gong and T’ai chi. There is some evidence which suggests the importance of the “reciprocal body-mind relationship” in reducing patient subjective perception of pain and symptom severity.54,55 Mind-body therapies serve this role. All articles from this review demonstrate the trend that whites use mind-body therapies more than blacks. However, in many instances the difference in use is less than 5%. Blacks have been shown to use CAM for various health conditions. The most studied condition surveyed has been diabetes. Two articles stated blacks used CAM for diabetes more than whites and two stated the inverse, that white diabetics used CAM more often. For asthma the chief form of CAM used by blacks was prayer. Similarly for black AIDS patients the chief form of CAM utilized by them was prayer. Regarding herbal product use by blacks, they were found by Mehta et al. to be less likely than whites to report herbal product use to their medical doctor.


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Study Limitations

Due to the limited number of black CAM-use articles, and overlapping data sets of many of them, the summary of this paper may not reflect the true reality of CAM usage of this population. With some surveys there is the possibility of issues with the participant understanding the questions asked of them. This may be due to differing cultural backgrounds of participants receiving the survey. The extent to which this may have been an issue in many of the surveys referenced in this study has not been determined in research literature.

Conclusions

Non-Hispanic blacks do not appear to utilize CAM as frequently as whites, with the exception of prayer. Additionally, blacks do not use chiropractic services as often as whites. If CAM use can in fact beneficially impact their health then the barriers that exist which prevent them from using CAM should be studied further. By collecting additional survey data on these CAM use barriers countermeasures may be considered.

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