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a Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
b Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
c Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
d Department of Family Medicine, University of Texas Health Service Center at San Antonio
Jose A. Loera, University of Texas Medical Branch, 301 University Blvd., Galveston, Texas 77555-0460 E-mail: jloera{at}utmb.edu.
Decision Editor: John E. Morley, MB, BCh
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Abstract |
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Methods. We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California.
Results. The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview.
Conclusions. Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.
DURING the past decade, the adult U.S. population has shown an increasing interest in the use of complementary or alternative medicine. The number of people stating that they have used alternative medicine increased from 33.8% in 1990 to 42.1% in 1997 (1). Many adults use alternative treatments in conjunction with allopathic medicines, especially when treating certain chronic conditions such as arthritis (2)(3)(4). The rising popularity of alternative therapies could represent an attempt to lower health care expenses by substituting less expensive alternative medicines for prescription medicines (5), in addition to dissatisfaction with allopathic therapies (3).
Concerns have been raised about the quality and safety of complementary alternative medicine products, particularly because many herbal medicines, homeopathic remedies, vitamins, and nutritional supplements can be purchased directly from health food stores, mail- and internet-order catalogs, and mainstream food markets and pharmacies without the proper information on interaction with prescription and over-the-counter (OTC) medications (6)(7)(8).
Herbal medicine use has traditionally been associated with ethnic populations, particularly among elders (9)(10)(11). Recent trends have shown an increasing use of herbal medications by various ethnic groups (7)(10). Little is known, however, about the frequency and patterns of the use of herbal medicines by older Mexican Americans.
The purpose of this study was to provide more information about patterns and correlates of use of herbal medicines by older Mexican Americans.
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Methods |
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Measures
Respondents were asked if they had taken or used any folk medicine, herbs, or herbal remedy during the 2 weeks prior to the baseline interview. Individuals who responded in the affirmative were then asked to show interviewers the container of the herbal remedy. The interviewers collected the following information from the container label: dosage, route of administration, and frequency of usage. Respondents were also asked similar questions pertaining to their use of prescription and OTC medications during the 2 weeks prior to interview.
Sociodemographic measures included the respondents' age, gender, years of education, current marital status, living arrangements (number of persons residing in the household), if they had been born in the United States or in Mexico, and if they had any type of health-insurance coverage. Respondents were also asked how often they did not have enough money to afford the kind of food and the kind of medical care they needed, with responses including never, once in a while, fairly often, and very often. Those respondents who reported not having enough money fairly often or very often were categorized as having financial strain. We originally intended to include a measure of household income but found that it was very highly correlated with education and financial strain.
Health-related measures included a number of self-reported, physician-diagnosed medical conditions including cardiac problems, diabetes, stroke, hypertension, cancer, arthritis, hip fracture, urinary and bowel incontinence, and asthma. Self-reported disabilities in bathing, dressing, grooming, eating, transferring from bed to chair, using a toilet, and walking were measured with a modified version of the Katz Activities of Daily Living (ADL) scale (14). Respondents were also asked if they had needed to cut down on their activities during the 3 months prior to the interview, how they rated their health (excellent, good, fair, or poor), and how satisfied they were with life. Psychological distress was measured with the Center for Epidemiologic Studies Depression Scale (CES-D) (15). Responses to the CES-D were scored on a four-point scale, with potential total scores ranging from 0 to 60. The standard cut point of 16 or greater was used to distinguish symptomatology in the clinical range (16). Respondents were asked how many times they had seen a physician during the year prior to interview and were categorized as very-high-frequency users of formal health care services if they reported 24 or more visits.
Analyses
The rates of herbal medicine use were assessed for the sample as a whole and by sociodemographic and health-related measures. Differences in the rates across independent variables were assessed using the chi-square statistic. Logistic regression was then employed to model the use of herbal medicine, first with sociodemographic characteristics and then for each of the health-related measures, controlling for the influence of the sociodemographics. All analyses incorporated weighted data that were adjusted for design effects to produce results that were representative of the older Mexican-American population in the five-state region. Analyses were conducted using SAS (17), and confidence intervals were computed using SUDAAN (18).
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Table 4 presents the results of a series of multiple logistic regressions that modeled the use of herbal medicine in this population. The first analysis included only the sociodemographic characteristics as independent variables. As can be seen in the table, female gender, being age 75 and older, living alone, being an immigrant, and reporting financial strain remained significant predictors of herbal medicine usage even when controlling for other sociodemographic factors.
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Discussion |
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This study should be interpreted with an understanding of the limitations in its methodology. First, our estimates of herbal medicine use represent a point prevalence: the percentage of individuals who used herbal medications in the 2 weeks prior to the interview. This method would underestimate those who used herbal medications on an as-needed basis for medical conditions such as an upper respiratory infection or upset stomach. Because the methodology selected for chronic users of herbal medications, it is not unexpected that herbal use correlated with the presence of several chronic medical conditions. Second, although we found associations between the use of herbal medicines and certain medical conditions, we did not ask the subjects for the specific reasons why they were taking a particular herbal medicine. Finally, we did not determine how the subjects came to be using a particular herbal medication; for example, whether it was prescribed by a practitioner or recommended by a family member or friend.
This study has several strengths, the most important of which is the sampling design, which allows us to make valid estimates of herbal medication use for the entire older Mexican-American population in the five southwestern states. In addition, the longitudinal design of the study should allow for the examination of changes in the pattern of herbal medication use over time.
A possible explanation for the pattern of herbal medicine use associated with certain chronic diseases is the four conditions associated with increased herbal medicine use; three (arthritis, urinary incontinence, and asthma) are highly bothersome chronic conditions for which less than optimal treatments exist. In contrast, subjects who had experienced heart attacks were significantly less likely to use herbal medications. Heart attack is an acute life-threatening condition requiring hospitalization and normally leads to lifestyle changes and close medical supervision of blood pressure and serum lipid levels.
Herbal medicine users were more likely to be immigrants, which is also consistent with previous reports (19). Literature on Hispanics' access to health care has proposed that recent Mexican-American immigrants rely more on herbal medicines than on allopathic medicine because of limited access to medical care. Hispanic families are 2.5 times as likely to live below the poverty level (10)(11). The Council on Scientific Affairs also noted that poverty and lack of health insurance affected Hispanics' choice between allopathic therapies and herbal medicine (11). Although we did not find an association of herbal medicine use with access to medical care as measured by insurance coverage, we did find that those respondents who reported a very high frequency of visits made to allopathic physicians were two to three times as likely to use herbal medicines as those with less frequent visits. Similar findings were reported by Druss and Rosenheck (20), who, using data from the Medical Expenditure Panel Survey, found that among adults aged 18 and older, those in the highest quartile of number of physician visits were more than twice as likely to report the use of unconventional treatments.
Our findings are very much in keeping with previous studies, noting similar ailments or chronic medical conditions associated with a higher use of herbal medicine. We found that a majority of health-related measures were associated with elevated rates of herbal medicine and that rates were substantially higher among individuals reporting depressive symptoms. Among the most common problems identified by previous investigators to be associated with herbal medicine use among a variety of ethnicities were back pain, anxiety, arthritis (21), depression, and digestive conditions (4)(21).
Concerns have been raised regarding the quality and safety of herbal medicine products, although both chamomile and mint are seldom associated with adverse effects in the adult population (22)(23)(24). Chamomile and mint were the two most commonly used herbs in our study; both herbs appear to have a wide acceptance across cultural and geographic boundaries (25)(26). In fact, the ten herbal products listed in Table 2 are similar to the folk remedies reportedly used by the West Virginia population (22).
In summary, herbal medications are relatively common among older Mexican Americans with chronic medical conditions, particularly among those with limited financial resources. This profile contrasts sharply with the typical herbal medicine user found in mainstream society: the young and well educated, with substantial financial resources.
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Acknowledgments |
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Received September 11, 2000
Accepted November 15, 2000
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